title: Pre-transplant phospholipase A2 receptor autoantibody concentration is associated with clinically significant recurrence of membranous nephropathy post-kidney transplantation.
abstract: Previous studies that have assessed the association of pre-transplant antiphospholipase A2 receptor autoantibody (PLA2R-Ab) concentration with a recurrence of membranous nephropathy (rMN) post-kidney transplant have yielded variable results. We tested 16 consecutive transplant patients with a history of iMN for pre-transplant PLA2R-Ab. Enzyme-linked immunosorbent assay titers (Euroimmun, NJ, USA) >14 RU/mL were considered positive. A receiver operating characteristic (ROC) analysis was performed after combining data from Quintana et al. (n = 21; Transplantation February 2015) to determine a PLA2R-Ab concentration which could predict rMN. Six of 16 (37%) patients had biopsy-proven rMN at a median of 3.2 yr post-transplant. Of these, five of six (83%) had a positive PLA2R-Ab pre-transplant with a median of 82 RU/mL (range = 31-1500). The only patient who had rMN with negative PLA2R-Ab was later diagnosed with B-cell lymphoma. One hundred percent (n = 10) of patients with no evidence of rMN (median follow-up = five yr) had negative pre-transplant PLA2R-Ab. In a combined ROC analysis (n = 37), a pre-transplant PLA2R-Ab > 29 RU/mL predicted rMN with a sensitivity of 85% and a specificity of 92%. Pre-transplant PLA2R-Ab could be a useful tool for the prediction of rMN. Patients with rMN in the absence of PLA2R-Ab should be screened for occult malignancy and/or alternate antigens.
authors: Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors: Gaurav
authors: G
authors: Gupta
authors: Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors: Hasan
authors: H
authors: Fattah
authors: Division of Nephrology, Boston University School of Medicine, Boston, MA, USA.
authors: Rivka
authors: R
authors: Ayalon
authors: Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors: Jason
authors: J
authors: Kidd
authors: Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors: Todd
authors: T
authors: Gehr
authors: Servicio de Nefrología y Trasplante Renal, Hospital Clinic, Barcelona, Spain.
authors: Luis F
authors: LF
authors: Quintana
authors: Division of Transplant Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors: Pamela
authors: P
authors: Kimball
authors: Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors: Salima
authors: S
authors: Sadruddin
authors: Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors: H Davis
authors: HD
authors: Massey
authors: Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors: Dhiren
authors: D
authors: Kumar
authors: Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors: Anne L
authors: AL
authors: King
authors: Division of Nephrology, Boston University School of Medicine, Boston, MA, USA.
authors: Laurence H
authors: LH
authors: Beck
mesh_terms: D001323:Autoantibodies / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D015433:Glomerulonephritis, Membranous / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D006084:Graft Rejection / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012372:ROC Curve; D054507:Receptors, Phospholipase A2 / Q000276:immunology*; D012008:Recurrence; D012307:Risk Factors
chemical_list: D001323:Autoantibodies; D054507:Receptors, Phospholipase A2
keywords: antiphospholipase A2 receptor autoantibody; idiopathic membranous nephropathy; kidney transplantation; recurrent membranous nephropathy