Coche Sophie, Sprangers Ben, Van Laecke Steven, Weekers Laurent, De Meyer Vicky, Hellemans Rachel, Castanares Diego, Ameye Heleen, Goffin Eric, Demoulin Nathalie, Gillion Valentine, Mourad Michel, Darius Tom, Buemi Antoine, Devresse Arnaud, Kanaan Nada
Division of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Division of Nephrology, Katholieke Universiteit Leuven, Leuven, Belgium.
Kidney Int Rep. 2021 Apr 28;6(7):1888-1894. doi: 10.1016/j.ekir.2021.04.011. eCollection 2021 Jul.
Recurrence of anti-glomerular basement membrane (anti-GBM) glomerulonephritis in the kidney graft is a rare event, described in limited reports. The aim of this study was to evaluate, in a large cohort of patients with long follow-up, the risk of recurrence of anti-GBM disease, the risk factors associated with clinical recurrence, and the long-term patient and graft survival.
This was a multicenter retrospective study. Inclusion criteria were patients with anti-GBM glomerulonephritis who underwent transplantation of a kidney between 1977 and 2015. Exclusion criteria were systemic vasculitis, lupus erythematosus, and cryoglobulinemia. Recurrence was defined as reappearance of clinical signs of glomerulonephritis along with histological signs of proliferative glomerulonephritis and linear IgG staining on kidney biopsy, with or without anti-GBM antibodies.
A total of 53 patients were included. Recurrence of anti-GBM glomerulonephritis in a first kidney transplant occurred in only 1 patient 5 years after transplantation (a prevalence rate of 1.9%) in the context of cessation of immunosuppressive drugs, and resulted in graft loss due to recurrence. Linear IgG staining on kidney biopsy in the absence of histological signs of proliferative glomerulonephritis was observed in 4 patients, in the context of cellular rejection. Patient survival was 100%, 94%, and 89% at 5, 10, and 15 years, respectively. Death-censored first-graft survival rates were 88%, 83%, and 79% at 5, 10, and 15 years, respectively.
The recurrence rate of anti-GBM glomerulonephritis after transplantation is very low but is associated with graft loss. The long-term patient and graft survival rates are excellent.
肾移植中抗肾小球基底膜（anti-GBM）肾小球肾炎复发是一种罕见事件，仅有有限的报道。本研究旨在评估一大群长期随访患者中抗GBM疾病的复发风险、与临床复发相关的危险因素以及患者和移植物的长期生存率。
这是一项多中心回顾性研究。纳入标准为1977年至2015年间接受肾移植的抗GBM肾小球肾炎患者。排除标准为系统性血管炎、红斑狼疮和冷球蛋白血症。复发定义为肾小球肾炎临床症状再次出现，同时伴有增生性肾小球肾炎的组织学表现以及肾活检显示线性IgG染色，无论是否存在抗GBM抗体。
共纳入53例患者。首例肾移植中抗GBM肾小球肾炎复发仅发生在1例患者中，移植后5年（患病率为1.9%），发生在停用免疫抑制药物的情况下，并因复发导致移植物丢失。在4例患者中，在细胞排斥的情况下，肾活检发现无增生性肾小球肾炎组织学表现的线性IgG染色。患者5年、10年和15年的生存率分别为100%、94%和89%。死亡校正后的首例移植物生存率在5年、10年和15年分别为88%、83%和79%。
移植后抗GBM肾小球肾炎的复发率非常低，但与移植物丢失有关。患者和移植物的长期生存率良好。
