Recurrence of membranous nephropathy after kidney transplantation: a multicenter retrospective cohort study.

Membranous nephropathy (MN) is a leading cause of kidney failure worldwide, and frequently recurs after transplant. Available data originated from small retrospective cohort studies or registry analyses. Therefore, uncertainties remain on risk factors for MN recurrence and response to therapy. Within the Post-Transplant Glomerular Disease (TANGO) Consortium, we conducted a retrospective multicenter cohort study examining the MN recurrence rate, risk factors, and response to treatment. This study screened 22,921 patients across three continents and included 194 patients who underwent a kidney transplant due to biopsy-proven MN. The cumulative incidence of MN recurrence was 31% at 10 years post-transplant. Patients with a faster progression towards end-stage kidney disease (ESKD) were at higher risk of developing recurrent MN (hazard ratio (HR) of 0.55 per decade (95%CI; 0.35-0.88). Moreover, elevated pre-transplant levels of anti-PLA2R antibodies were strongly associated with recurrence (HR 18.58; 95%CI; 5.37- 64.27). Patients receiving rituximab for MN recurrence had a higher likelihood of achieving remission than patients receiving RAAS inhibition alone. In sum, MN recurs in one-third of patients post-transplant and serum PLA2R antibodies shortly before transplant could aid in risk-stratifying patients for MN recurrence. Moreover, patients receiving rituximab had a higher rate of treatment response.