Andresdottir M B, Assmann K J, Hoitsma A J, Koene R A, Wetzels J F
Department of Pathology, University Hospital Nijmegen, The Netherlands.
Transplantation. 1997 Jun 15;63(11):1628-33. doi: 10.1097/00007890-199706150-00016.
The information in the medical literature on the incidence of recurrence of type I membranoproliferative glomerulonephritis (MPGN) after renal transplantation and its impact on graft survival is limited because most data are derived from case reports or from studies involving a small number of patients.
We analyzed the data from our transplant center. Among 1097 adult patients receiving their first allograft between 1977 and 1994, we identified 32 patients with type I MPGN.
A recurrence was detected in 9 of the 27 recipients of a first cadaveric graft (33%). The cumulative incidence reached 48% at 4 years after transplantation when patients with graft failure from other causes were censored. All patients with recurrent MPGN had clinically significant proteinuria (>1 g/24 hr) that was first observed at a median time of 20 months (range, 1.5-42 months) after transplantation. Graft survival was significantly worse in patients with recurrence as compared with patients without recurrence. Mean duration of graft survival after the diagnosis of recurrence was 40 months. We could not detect any clinical characteristics of patients or donors that were associated with recurrent disease. However, an increased risk of recurrence was observed in patients with the HLA haplotype B8DR3. Four patients received an HLA-identical graft from a living related donor. Recurrence occurred in three patients (75%), with ensuing graft loss in two. The only patient with a haploidentical living related graft did not have a recurrence. Five patients with a recurrence in the first graft received a second transplant. Recurrence was observed in four of these patients (80%).
Type I MPGN recurred after renal transplantation in half of the patients. The incidence may be even higher in recipients of an identical living related donor graft and in patients receiving a second transplant after having experienced a recurrence in their first graft. Recurrence of type I MPGN has a detrimental effect on graft survival.
医学文献中关于Ⅰ型膜增生性肾小球肾炎（MPGN）肾移植后复发率及其对移植肾存活影响的信息有限，因为大多数数据来自病例报告或涉及少数患者的研究。
我们分析了本移植中心的数据。在1977年至1994年间接受首次同种异体移植的1097例成年患者中，我们确定了32例Ⅰ型MPGN患者。
在27例首次接受尸体供肾移植的受者中，有9例出现复发（33%）。当剔除因其他原因导致移植肾失功的患者后，移植后4年的累积复发率达到48%。所有复发MPGN的患者均有临床上显著的蛋白尿（>1 g/24小时），首次出现蛋白尿的中位时间为移植后20个月（范围1.5 - 42个月）。与未复发患者相比，复发患者的移植肾存活情况明显更差。复发诊断后的移植肾平均存活时间为40个月。我们未发现患者或供者的任何临床特征与疾病复发相关。然而，观察到具有HLA单倍型B8DR3的患者复发风险增加。4例患者接受了来自活体亲属供者的HLA相同移植肾。3例患者（75%）出现复发，其中2例移植肾丢失。唯一接受单倍型相同活体亲属移植肾的患者未复发。5例首次移植肾复发的患者接受了第二次移植。其中4例患者（80%）出现复发。
Ⅰ型MPGN在肾移植后半数患者中复发。在接受相同活体亲属供者移植肾的受者以及首次移植肾复发后接受第二次移植的患者中，复发率可能更高。Ⅰ型MPGN复发对移植肾存活有不利影响。
