Outcome of renal transplantation in fibrillary glomerulonephritis

Fibrillary glomerulonephritis (FGN) is a rare but progressive glomerular di sease usually with end-stage renal disease (ESRD) developing within months or few years following the diagnosis. Little is known about the outcome of renal transplantation in patients with ESRD due to FGN. We report four pati ents with FGN who received renal allografts. Two patients developed recurre nt FGN in their grafts. One patient was diagnosed to have recurrent FGN 9 y ears post-transplant, and lost his graft 4 years thereafter. Another patien t had recurrent disease 2 years post-transplant but has stable graft functi on after 7 years. One patient died with normal renal allogaft function 7 ye ars following transplantation. The fourth patient has chronic transplant ne phropathy 3 months post-transplant without evidence of recurrent FGN. A lit erature review revealed 10 additional patients who received I I renal allog rafts due to ESRD caused by FGN. Four of these 10 patients had biopsy-prove n recurrence (one patient in two subsequent grafts), but this caused graft loss only in 2 patients 56 months and 7 years post-transplant, respectively . The earliest recurrence was diagnosed 2 years post-transplant. We conclud e that although the recurrence rate of FGN in renal transplants is high (ar ound 50%), the recurrent disease has a relatively benign course and prolong ed graft survival is possible.