LONG-TERM OUTCOMES IN KIDNEY TRANSPLANT RECIPIENTS WITH MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS – A NATIONWIDE COHORT STUDY

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Abstract Title *

LONG-TERM OUTCOMES IN KIDNEY TRANSPLANT RECIPIENTS WITH MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS – A NATIONWIDE COHORT STUDY

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Co-author 1

Rune Bjørneklett rune.bjorneklett@uib.no University of Bergen Dep of Clinical Medicine Bergen Norway *

Co-author 2

Henrik Stenestø Foshaug henrik.stenesto.foshaug@helse-bergen.no Haukeland University Hospital Dep. of Medicine Bergen Norway -

Co-author 3

Øystein Eikrem oystein.eikrem@uib.no University of Bergen Dep of Clinical Medicine Bergen Norway -

Co-author 4

Thomas Knoop thomas.knoop@helse-bergen.no Haukeland University Hospital Dep of Medicine Bergen Norway -

Co-author 5

Melinda Raki melrak@ous-hf.no Oslo University Hospital Dep of Pathology Oslo Norway -

Co-author 6

Christina Dørje cdorje@ous-hf.no Oslo University Hospital Dep of Transplantation Medicine Oslo Norway -

Co-author 7

Kristian Heldal hkri@ous-hf.no Oslo University Hospital Dep of Transplantation Medicine Oslo Norway -

Co-author 8

Yngvar Haaskjold yngvarhaaskjold@gmail.com St Olav University Hospital Dep of Nephrology Trondheim Norway -

Co-author 9

Anders Åsberg anders.asberg@farmasi.uio.no University of Oslo Dep of Pharmacy Oslo Norway -

Co-author 10

Njål Lura njal.gjerde.lura@helse-bergen.no Haukeland University Hospital Dep of Radiology Bergen Norway -

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Membranoproliferative glomerulonephritis (MPGN) is rare but has an aggressive disease course with most patients progressing to end-stage kidney disease (ESKD). A substantial proportion of patients experience disease recurrence following kidney transplantation, which is associated with a significantly increased risk of graft loss. Data on long-term outcomes and risk stratification after transplantation remain limited.

Methods

We conducted a nationwide retrospective cohort study including all patients in Norway with biopsy-confirmed membranoproliferative patterns of glomerular injury diagnosed between 1991 and 2012, who had received at least one kidney transplant prior to the end of follow-up in May 2024. Clinical, histopathological, and transplantation data were obtained from national registries and patient records. The primary endpoints were MPGN recurrence and graft loss due to recurrence.

Results

A total of 44 patients (24 male, 20 female) were included. The median follow-up time from the time of native kidney biopsy to the last follow-up was 18.4 years (range: 2.3–36.1 years), while the median time from first kidney transplantation to last follow-up was 12.1 years (range: 0.9–32.6 years). Recurrence of MPGN in the first graft occurred in 18 patients (41%), with a median time to recurrence of 20.0 months. Graft loss occurred in 11 of 18 patients with recurrence, compared to 6 of 26 without recurrence. Living donor transplantation was significantly associated with increased risk of recurrence and graft loss (HR 6.03, p = 0.02). A large proportion of patients (70%) had no identifiable underlying disease and were classified as idiopathic. Among patients who underwent retransplantation, recurrence and graft loss remained frequent.

Conclusion

Recurrence of MPGN after kidney transplantation is common and associated with worse graft survival. Living donor transplantation and complement-mediated disease are significant risk factors for recurrence and graft loss. The high proportion of idiopathic cases with aggressive disease highlights the need for improved risk stratification and individualized management in this patient group.

Kewords