title: Allograft failure in kidney transplant recipients with membranoproliferative glomerulonephritis.
abstract: BACKGROUND
  Membranoproliferative glomerulonephritis types I (MPGN-I) and II (MPGN-II) are rare diseases that in limited case series have been reported to recur frequently in kidney transplants and have a negative impact on allograft survival.
  
  
  METHODS
  Retrospective database review.
  
  
  METHODS
  189,211 primary kidney transplants in the United Network for Organ Sharing (UNOS) database from September 1987 to May 2007.
  
  
  METHODS
  MPGN-I (811 patients; 0.4%), MPGN-II (179 patients; 0.1%), other GN (58,129 patients; 30.7%), and all other diagnoses (130,092 patients; 68.7%).
  
  
  RESULTS
  Death-censored and non-death-censored allograft survival.
  
  
  RESULTS
  Compared with controls, patients with MPGN-I and MPGN-II were significantly younger at the time of transplant, with a median age of 36 and 27 years compared with 44 years in the GN group and 46 years in all other disease groups, respectively (all P < 0.001). Mortality in patients with MPGN-I (8.8%) was significantly lower compared with the GN (11.3%; P = 0.02) and other disease (16.6%; P < 0.001) populations and lower in those with MPGN-II (9.5%) compared with the other disease (16.6%; P = 0.01) population. Graft failure rates were significantly higher in the MPGN-I (44.5%) cohort, but not in the MPGN-II (45.3%) cohort compared with the GN (38.0%) population (P < 0.001 and P = 0.05, respectively); neither MPGN cohort differed from the other disease (43.0%) population (P = 0.4 and P = 0.5). Overall, 10-year death-censored graft survival was similar for MPGN-I (56.2%) and MPGN-II (57.5%); both were significantly worse than for GN (65.2%; P < 0.001 and P = 0.003, respectively), and only MPGN-I was significantly worse than the other disease (60.0%) population (P = 0.004). Of allograft failures with a reported cause, disease recurrence was the primary cause in 36 (14.5%) MPGN-I and 18 (29.5%) MPGN-II transplant recipients and was significantly higher compared with 879 (6.6%) GN and 1,319 (4.4%) all-other-disease recurrence failures (P < 0.001).
  
  
  CONCLUSIONS
  Limited pretransplant clinical and biopsy data.
  
  
  CONCLUSIONS
  A diagnosis of MPGN-I or MPGN-II has a significant negative impact on overall primary allograft survival compared with other forms of glomerulonephritis, whereas only MPGN-I has a significant, but modest, negative effect compared with other causes of end-stage renal disease.
authors.affiliation: Department of Pediatrics, The University of Texas Medical School at Houston, USA.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Angelo
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Bell
authors.forename: Michael C
authors.initials: MC
authors.lastname: Braun
mesh_terms: D000328:Adult; D005260:Female; D015432:Glomerulonephritis, Membranoproliferative / Q000401:mortality / Q000601:surgery*; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D014184:Transplantation, Homologous