RECURRENCE OF TYPE-I MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS AFTER RENAL-TRANSPLANTATION - ANALYSIS OF THE INCIDENCE, RISK-FACTORS, AND IMPACT ON GRAFT-SURVIVAL

Background. The information in the medical literature on the incidence of recurrence of type I membranoproliferative glomerulonephritis (MPG N) after renal transplantation and its impact on graft survival is lim ited because most data are derived from case reports or from studies i nvolving a small number of patients. Methods. We analyzed the data fro m our transplant center. Among 1097 adult patients receiving their fir st allograft between 1977 and 1994, we identified 32 patients with typ e I MPGN. Results. 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 fr om other causes were censored. All patients with recurrent MPGN had cl inically significant proteinuria (>1 g/24 hr) that was first observed at a median time of 20 months (range, 1.5-42 months) after transplanta tion. Graft survival was significantly worse in patients with recurren ce as compared with patients without recurrence. Mean duration of graf t survival after the diagnosis of recurrence was 40 months. We could n ot detect any clinical characteristics of patients or donors that were associated with recurrent disease. However, an increased risk. of rec urrence was observed in patients with the HLA haplotype B8DR3. Four pa tients received an HLA-identical graft from a living related donor. Re currence occurred in three patients (75%), with ensuing graft loss in two. The only patient with a haploidentical living related graft did n ot have a recurrence. Five patients with a recurrence in the first gra ft received a second transplant. Recurrence was observed in four of th ese patients (80%). Conclusions. Type I MPGN recurred after renal tran splantation in half of the patients. The incidence may be even higher in recipients of an identical living related donor graft and in patien ts receiving a second transplant after having experienced a recurrence in their first graft. Recurrence of type I MPGN has a detrimental eff ect on graft survival.