Bai Jiang, Zheng Zhifang, Cao Jiajing, Ji Linghui, Zhang Junchi, Yang Yanan, Guo Qiang
Second Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi, China.
Department of Pediatrics, Shanxi Medical University, Taiyuan, Shanxi, China.
Ann Med. 2025 Dec;57(1):2522971. doi: 10.1080/07853890.2025.2522971. Epub 2025 Jun 27.
The risk factors for membranous nephropathy (MN) following kidney transplantation remain unclear, mainly attributed to the constrained identification of predictive clinical presentation features. This study aims to conduct a systematic review to analyse the risk factors associated with recurrent MN.
Starting from its establishment until March 2023, we conducted a screening of case-control studies focusing on recurrent MN in various databases including PubMed, Embase, Web of Science, Medline, the Cochrane Library, CNKI, Wanfang, CBMdisc and Weipu. The protocol was registered on PROSPERO (CRD42022315448). A meta-analysis was carried out to examine the risk factors for recurrent MN, and statistical analysis was performed using Stata 12.0.
This meta-analysis included a total of eight case-control studies with 108 patients with recurrent MN and 298 without recurrence. The results showed the incidence of recurrent MN after kidney transplantation was 34%. A higher rate of recurrent MN detected through surveillance biopsies was observed compared to indication biopsies. Living donor [OR = 1.89, 95%CI (1.12, 3.19), and = 0.017], anti-phospholipase A2 receptor autoantibody (anti-PLA2R) levels before transplantation [OR = 10.16, 95%CI (3.16, 32.62), and < 0.001] and a shorter duration of dialysis [weighted mean difference (WMD) = -14.36 mo, 95%CI (-24.60, -4.13), and = 0.006] were associated with a risk for recurrent MN; induction immunosuppression [OR = 0.24, 95%CI (0.10, 0.58), and = 0.001] and tacrolimus use [OR = 0.23, 95%CI (0.09, 0.61), and = 0.003] were protective factors for recurrent primary MN, whereas sex, age, time from MN to end-stage renal disease (ESRD), re-transplantation, and race (white) were not associated with recurrent MN.
Recurrence of MN persists with a high rate. These factors should be carefully evaluated in clinical decision-making, encompassing living donor selection, pre-transplant anti-PLA2R levels, dialysis, choice of induction immunosuppression, and tacrolimus use.
肾移植后膜性肾病（MN）的危险因素尚不清楚，主要原因是预测临床表现特征的识别受限。本研究旨在进行系统评价，以分析与复发性MN相关的危险因素。
从建库至2023年3月，我们在包括PubMed、Embase、Web of Science、Medline、Cochrane图书馆、中国知网、万方、中国生物医学文献数据库和维普在内的多个数据库中筛选了聚焦复发性MN的病例对照研究。该方案已在PROSPERO（CRD42022315448）上注册。进行荟萃分析以检验复发性MN的危险因素，并使用Stata 12.0进行统计分析。
该荟萃分析共纳入8项病例对照研究，其中108例为复发性MN患者，298例未复发。结果显示，肾移植后复发性MN的发生率为34%。与指征性活检相比，通过监测性活检检测到复发性MN的比例更高。活体供肾[比值比（OR）=1.89，95%置信区间（CI）（1.12，3.19），P=0.017]、移植前抗磷脂酶A2受体自身抗体（抗PLA2R）水平[OR = 10.16，95%CI（3.16，32.62），P<0.001]以及较短的透析时间[加权均数差（WMD）=-14.36个月，95%CI（-24.60，-4.13），P=0.006]与复发性MN的风险相关；诱导免疫抑制[OR = 0.24，95%CI（0.10，0.58），P=0.001]和使用他克莫司[OR = 0.23，95%CI（0.09，0.61），P=0.003]是复发性原发性MN的保护因素，而性别、年龄、从MN到终末期肾病（ESRD）的时间、再次移植和种族（白人）与复发性MN无关。
MN的复发率仍然很高。在临床决策中应仔细评估这些因素，包括活体供肾的选择、移植前抗PLA2R水平、透析、诱导免疫抑制的选择以及他克莫司的使用。
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