and recurrent post-transplant membranous nephropathy cases show similar rates of concurrent antibody-mediated rejection.

BACKGROUND

Membranous nephropathy (MN) can develop post-kidney transplant and is classified as a recurrent disease in patients with a history of MN in the native kidneys or as disease in patients without such history. The mechanism of recurrent MN is thought to be like that of primary MN, but the mechanism of MN is not well delineated. An association between MN and antibody-mediated rejection (AMR) has been suggested.

METHODS

A search of the pathology database from our medical center identified 11 cases of recurrent and 15 cases of MN, in which clinical and histologic findings were compared. No significant differences were identified in the demographic characteristics, serum creatinine and proteinuria trends, or rates of allograft failure between the recurrent and MN groups.

RESULTS

Rates of concurrent AMR were high in both groups (36% and 40%, respectively) but not statistically different from each other. PLA2R immunofluorescence (IF) positivity was seen in 64% of recurrent MN cases compared to 33% of MN cases, suggesting a higher incidence of PLA2R-positive MN than previously reported. No significant histologic differences were identified in the initial biopsies from the two groups, except mean IgG intensity by IF was higher in the recurrent group, suggesting a higher load of immune complex deposits at diagnosis in this group.

CONCLUSION

The findings do not provide support for a specific association between AMR and MN, but whether there is a possible link between both forms of post-transplant MN and AMR remains an unanswered question.