Anti‐Phospholipase A2 Receptor Antibodies in Recurrent Membranous Nephropathy

• Published in: American journal of transplantation Vol. 15; no. 5; pp. 1349 - 1359
• Main Authors: Kattah, A., Ayalon, R., Beck, L. H., Sethi, S., Sandor, D. G., Cosio, F. G., Gandhi, M. J., Lorenz, E. C., Salant, D. J., Fervenza, F. C.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.05.2015
• Subjects: Adult; Aged; Biopsy; Clinical research; Drug therapy; Female; glomerular biology and disease; Glomerulonephritis, Membranous - immunology; Graft Survival; Humans; Immunosuppression Therapy - methods; Immunosuppressive Agents - therapeutic use; Kidney Failure, Chronic - surgery; kidney transplantation; Longitudinal Studies; Male; Medical research; Middle Aged; nephrology; practice; Predictive Value of Tests; Proteinuria - immunology; Receptors, Phospholipase A2 - chemistry; Receptors, Phospholipase A2 - immunology; Recurrence; recurrent disease; Retrospective Studies; Treatment Outcome; nephrology; Clinical research; practice; glomerular biology and disease; recurrent disease; kidney transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.13133

About 70% of patients with primary membranous nephropathy (MN) have circulating anti‐phospholipase A2 receptor (PLA2R) antibodies that correlate with disease activity, but their predictive value in post‐transplant (Tx) recurrent MN is uncertain. We evaluated 26 patients, 18 with recurrent MN and 8 without recurrence, with serial post‐Tx serum samples and renal biopsies to determine if patients with pre‐Tx anti‐PLA2R are at increased risk of recurrence as compared to seronegative patients and to determine if post‐Tx changes in anti‐PLA2R correspond to the clinical course. In the recurrent group, 10/17 patients had anti‐PLA2R at the time of Tx versus 2/7 patients in the nonrecurrent group. The positive predictive value of pre‐Tx anti‐PLA2R for recurrence was 83%, while the negative predictive value was 42%. Persistence or reappearance of post‐Tx anti‐PLA2R was associated with increasing proteinuria and resistant disease in 6/18 cases; little or no proteinuria occurred in cases with pre‐Tx anti‐PLA2R and biopsy evidence of recurrence in which the antibodies resolved with standard immunosuppression. Some cases with positive pre‐Tx anti‐PLA2R were seronegative at the time of recurrence. In conclusion, patients with positive pre‐Tx anti‐PLA2R should be monitored closely for recurrent MN. Persistence or reappearance of antibody post‐Tx may indicate a more resistant disease. This case series of patients with end‐stage primary membranous nephropathy undergoing renal transplant uses serial posttransplant protocol biopsies and serum collections to describe the changes in anti‐PLA2R antibodies and tissue staining for the PLA2R antigen before and after transplant, and to correlate these changes with clinical outcomes.