Recurrence and outcome of anti-GBM glomerulonephritis after kidney transplantation

Abstract Introduction Recurrence of anti-glomerular basement membrane (anti-GBM) glomerulonephritis in the kidney graft is a rare event, described in limited reports. The aim of this study was to evaluate in a large cohort of patients with long follow-up the risk of recurrence of anti-GBM disease, the risk factors associated with clinical recurrence and the long-term patient and graft survival. Methods Multicenter retrospective study. Inclusion criteria: patients with anti-GBM glomerulonephritis transplanted with a kidney between 1977 and 2015. Exclusion criteria: systemic vasculitis, lupus erythematosus and cryoglobulinemia. Recurrence was defined as reappearance of clinical signs of glomerulonephritis along with histological signs of proliferative glomerulonephritis and linear IgG staining on kidney biopsy, with or without anti-GBM antibodies. Results Fifty-three patients were included. Recurrence of anti-GBM glomerulonephritis in a first kidney transplant occurred only in one patient five years after transplantation -a prevalence rate of 1.9%- in the context of cessation of immunosuppressive drugs, and resulted in graft loss due to recurrence. Linear IgG staining on kidney biopsy in the absence of histological signs of proliferative glomerulonephritis was observed in four patients, in the context of cellular rejection. Patient survival was 100%, 94% and 89% at 5, 10 and 15 years, respectively. Death-censored first graft survival rates were 88%, 83% and 79% at 5, 10 and 15 years, respectively. Conclusion The recurrence rate of anti-GBM glomerulonephritis after transplantation is very low, but associated with graft loss. The long-term patient and graft survival rates are excellent.