Kidney Week

Abstract: SA-PO026

Kidney Transplantation Outcomes in Patients with Idiopathic Membranous Nephropathy as Primary Disease

Session Information

• Transplantation: Clinical Outcomes
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

• Lionaki, Sophia, Laiko Hospital, Athens, Greece

Sophia Lionaki,

• Akritidou, Sophia, Laiko Hospital, Athens, Greece

Sophia Akritidou,

• Mavroudi, Alexandra, Laiko Hospital, Athens, Greece

Alexandra Mavroudi,

• Liapis, Georgios, Laiko Hospital, Athens, Greece

Georgios Liapis,

• Iniotaki, Aliki, Gennimatas Hospital, Athens, Greece

Aliki Iniotaki,

• Zavos, Georgios, Laiko, Athens, Greece

Georgios Zavos,

• Boletis, John, Laiko Hospital, Athens, Greece

John Boletis,

Background

Kidney transplantation (KTx) is the treatment of choice for patients with glomerular diseases. However, in some occasions relapse of the primary disease in the graft may impact graft survival. We aimed to explore the outcome of KTx in patients who ended in ESRD due to idiopathic membranous nephropathy (IMN), the frequency of disease relapse in the graft along with the response to the current treatment options.

Methods

We retrospectively studied all patients with IMN as primary disease, transplanted in our hospital between 1990-2016. All patients had biopsy proven IMN in their native kidneys. Demographics and characteristics related to the donors and the recipients at KTx were recorded, including, dialysis time, immunosuppressive schemes, histocompatibility data, acute rejection episodes, patient and graft survival, and eGFR at the end of the follow up time. Relapses of IMN were recorded in conjunction with the given treatment and the related response. All patients with IMN relapse were initially treated with an ACE inhibitor (fosinopril) and depending on the response or not, received either the Ponticelli protocol, as 2^ndline therapy, or more recently rituximab.

Results

We identified 18 patients with ESRD due to IMN who received a graft between 1990-2016 in our hospital. The mean age at the time of KTx was 47±11.5 years and 13(72.2%) of them were males. The mean time in dialysis was 63.2(±51.5) months, the graft was from deceased donors in 13 cases (72.2%), with a mean donor age of 46(±15.46) years. During a follow up time of 84.97(±57.6) months after KTx, 7 patients (38.8%) experienced at least one episode of IMN relapse. Time to relapse was 45.6(±42.7) months from KTx and 24-hour proteinuria was 4.12(±2.88) gr. Two patients experienced acute rejection, one of them during the relapse of IMN. At the end of the follow up time, patients' survival was 100%, graft survival was 88.9%, with a mean serum creatinine of 1.8(±0.23) mg/dl, eGFR of 60.84 (±27.3) ml/min/1.73m² and mean 24-hour proteinuria of 0.75(±0.58) gr.

Conclusion

Relapse of IMN in the graft is not rare, but in most occasions is responsive to therapy, either with inhibition of the renin angiotensin system, either with enhancement of immunosuppressive treatment, and generally it does not affect long term graft survival.