Recurrence of membranoproliferative glomerulonephritis type II in renal allografts: The North American Pediatric Renal Transplant Cooperative Study experience.
Membranoproliferative glomerulonephritis type II (MPGN II) is an uncommon form of complement-dependent acquired renal disease. Although it has been recognized since the 1970s that MPGN II recurs almost universally in renal transplants, data regarding the long-term consequences of disease recurrence are limited. Therefore, a retrospective comparative analysis of 75 patients with MPGN II contained in the North American Pediatric Renal Transplant Cooperative Study transplantation database was performed. Five-year graft survival for patients with MPGN II was significantly worse (50.0 +/- 7.5%) compared with the database as a whole (74.3 +/- 0.6%; P < 0.001). Living related donor organs had a significantly better 5-yr survival (65.9 +/- 10.7%) compared with cadaveric donor organs (34.1 +/- 9.8%; P = 0.004). The primary cause of graft failure in 11 (14.7%) patients was recurrent disease. Supplemental surveys were obtained on 29 (38%) of 75 patients. Analysis of these data indicated that recurrent disease occurred in 12 (67%) of the 18 patients with posttransplantation biopsies. Although there was no correlation between pretransplantation presentation, pre- or posttransplantation C3 levels, and either disease recurrence or graft failure, there was a strong association between heavy proteinuria and disease recurrence. The presence of glomerular crescents in allograft biopsies had a significant negative correlation with graft survival. At last follow-up, patients with recurrent disease had significantly higher serum creatinine and qualitatively more proteinuria than patients without biopsy-proven disease. These data indicate that recurrent MPGN II has a significant negative impact on renal allograft function and survival.
Braun
Michael C
MC
The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston, 2121 W. Holcombe Boulevard, Houston, TX 77030, USA. michael.c.braun@uth.tmc.edu
Stablein
Don M
DM
Hamiwka
Lorraine A
LA
Bell
Lorraine
L
Bartosh
Sharon M
SM
Strife
C Frederic
CF
D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D015432:Glomerulonephritis, Membranoproliferative / Q000209:etiology* / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D009656:North America; D011507:Proteinuria / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D014184:Transplantation, Homologous / Q000009:adverse effects