title: Recurrent membranoproliferative glomerulonephritis type I after kidney transplantation: a 17-year single-center experience.
abstract: BACKGROUND
  Most previously published studies of patients with membranoproliferative glomerulonephritis type I are small or have short follow-up period. We report the outcome of a fairly large cohort of patients followed up for nearly 10 years.
  
  
  METHODS
  Retrospective cohort study. Graft survival, recurrence rate and risk factors for recurrence were analyzed for 43 patients transplanted between the years 1995 and 2012.
  
  
  RESULTS
  At a mean overall follow-up of 118 ± 61 months (median, 127.8; range, 4.9-217), 12 patients lost their graft (28%). Death-censored actuarial 15-year graft survival rate was 56%. Membranoproliferative glomerulonephritis recurred in eight patients (19%) at a median time of 15.4 months (range, 4.4-70 months). Recurrence led to graft loss in seven patients (88%) within a median of 11.6 months (range, 1.3-54 months) from diagnosis. Median graft survival was 30.5 months for recurrence (range, 7-86). Actuarial 15-year graft survival was 71% for nonrecurrent. The risk for recurrence was higher for patients with human leukocyte antigen (HLA) B49 (odds ratio, 16.9; 95% confidence interval, 1.1-246; P=0.038) and HLA DR4 (odds ratio, 15.9; 95% confidence interval, 1.07-237; P=0.044) alleles. A trend toward increased risk was found with shorter duration of dialysis before transplantation. Four of 16 (25%) living-related versus none of the living-unrelated donors' recipients recurred. The HLA B49, acute tubular necrosis after transplantation, previous transplantations, and Arab origin were all associated with decreased graft and patient survival.
  
  
  CONCLUSIONS
  Patients without recurrence in the first years should expect an excellent graft survival. Nonrelated living donors should be preferred. The HLA B49 and DR4 alleles may increase the risk for recurrence.
authors.affiliation: 1 Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel. 2 Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 3 Department of Transplantation, Rabin Medical Center, Petah-Tikva, Israel. 4 Department of Internal Medicine E, Rabin Medical Center, Petah-Tikva, Israel. 5 Department of Pathology, Rabin Medical Center, Petah-Tikva, Israel.
authors.forename: Hefziba
authors.initials: H
authors.lastname: Green
authors.forename: Ruth
authors.initials: R
authors.lastname: Rahamimov
authors.forename: Benaya
authors.initials: B
authors.lastname: Rozen-Zvi
authors.forename: Barak
authors.initials: B
authors.lastname: Pertzov
authors.forename: Ana
authors.initials: A
authors.lastname: Tobar
authors.forename: Shelly
authors.initials: S
authors.lastname: Lichtenberg
authors.forename: Uzi
authors.initials: U
authors.lastname: Gafter
authors.forename: Eytan
authors.initials: E
authors.lastname: Mor
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D015432:Glomerulonephritis, Membranoproliferative / Q000209:etiology* / Q000276:immunology; D006084:Graft Rejection / Q000209:etiology / Q000276:immunology; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000235:genetics; D015235:HLA-B Antigens / Q000235:genetics; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D006680:HLA Antigens; D015235:HLA-B Antigens; C483912:HLA-B*49 antigen