Prediction of membranous nephropathy recurrence after transplantation by monitoring of anti-PLA2R1 (M-type phospholipase A2 receptor) autoantibodies: a case series of 15 patients
Open Access
- 25 July 2014
- journal article
- research article
- Published by Oxford University Press (OUP) in Nephrology Dialysis Transplantation
- Vol. 29 (12), 2334-2342
- https://doi.org/10.1093/ndt/gfu252
Abstract
The predictive value of anti-M-type phospholipase A2 receptor (PLA2R1) autoantibodies for membranous nephropathy (MN) recurrence after renal transplantation remains controversial. Our aim was to monitor anti-PLA2R1 IgG4 activity using a sensitive enzyme-linked immunosorbent assay in 15 kidney transplant recipients with MN, and to test the correlation between antibody titres and MN recurrence. Five patients never exhibited anti-PLA2R1 antibodies, and one of them relapsed. Ten patients (67%) had IgG4 anti-PLA2R1 antibodies at the time of transplantation and during follow-up. The presence of IgG4 anti-PLA2R1 antibodies at the time of kidney transplantation does not imply MN recurrence (P = 0.600, n = 15). However, a positive IgG4 anti-PLA2R1 activity during follow-up (> Month 6) was a significant risk factor for MN relapse (P = 0.0048, n = 10). Indeed, four patients had persistent IgG4 anti-PLA2R1 activity after transplantation and relapsed. Among them, one was successfully treated with rituximab. Another had persistently high IgG4 anti-PLA2R1 activity and exhibited a histological relapse but no proteinuria while on treatment with renin-angiotensin system inhibitors. In contrast, the six other patients who did not relapse exhibited a decrease of their IgG4 anti-PLA2R1 activity following transplant immunosuppression, including two with proteinuria due to biopsy-proven differential diagnoses. A weak transplant immunosuppressive regimen was also a risk factor of MN recurrence (P = 0.0048, n = 10). Indeed, the six patients who received both an induction therapy and a combined treatment with calcineurin inhibitors/mycophenolate exhibited a decrease of IgG4 anti-PLA2R1 activity and did not relapse, while the four patients who did not receive this strong immunosuppressive treatment association had persistently high IgG4 anti-PLA2R1 activity and relapsed. The monitoring of IgG4 anti-PLA2R1 titres during follow-up helps to predict MN recurrence, and a strong immunosuppressive treatment of anti-PLA2R1 positive patients may prevent recurrence.Keywords
This publication has 27 references indexed in Scilit:
- Autoantibodies Specific for the Phospholipase A2 Receptor in Recurrent and De Novo Membranous NephropathyAmerican Journal of Transplantation, 2011
- Rituximab-Induced Depletion of Anti-PLA2R Autoantibodies Predicts Response in Membranous NephropathyJournal of the American Society of Nephrology, 2011
- Anti-Phospholipase A2 Receptor Antibodies Correlate with Clinical Status in Idiopathic Membranous NephropathyClinical Journal of the American Society of Nephrology, 2011
- Anti-Phospholipase A2 Receptor Antibody in Membranous NephropathyJournal of the American Society of Nephrology, 2011
- An immunofluorescence test for phospholipase-A2-receptor antibodies and its clinical usefulness in patients with membranous glomerulonephritisNephrology Dialysis Transplantation, 2011
- Autoimmunity in Membranous Nephropathy Targets Aldose Reductase and SOD2Journal of the American Society of Nephrology, 2010
- M-Type Phospholipase A2Receptor as Target Antigen in Idiopathic Membranous NephropathyNew England Journal of Medicine, 2009
- Recurrent Idiopathic Membranous Nephropathy After Kidney Transplantation: A Surveillance Biopsy StudyAmerican Journal of Transplantation, 2008
- Recombinant Production and Properties of Binding of the Full Set of Mouse Secreted Phospholipases A2to the Mouse M-Type ReceptorBiochemistry, 2007
- Treatment of de novo and recurrent membranous nephropathy in renal transplant patientsSeminars in Nephrology, 2003