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Clin Transplant. 2016 Apr;30(4):461-9. doi: 10.1111/ctr.12711. Epub 2016 Mar 11.

Pre-transplant phospholipase A2 receptor autoantibody concentration is associated with clinically significant recurrence of membranous nephropathy post-kidney transplantation.

Author information

1
Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
2
Division of Nephrology, Boston University School of Medicine, Boston, MA, USA.
3
Servicio de Nefrología y Trasplante Renal, Hospital Clinic, Barcelona, Spain.
4
Division of Transplant Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
5
Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.

Abstract

Previous studies that have assessed the association of pre-transplant antiphospholipase A2 receptor autoantibody (PLA2R-Ab) concentration with a recurrence of membranous nephropathy (rMN) post-kidney transplant have yielded variable results. We tested 16 consecutive transplant patients with a history of iMN for pre-transplant PLA2R-Ab. Enzyme-linked immunosorbent assay titers (Euroimmun, NJ, USA) >14 RU/mL were considered positive. A receiver operating characteristic (ROC) analysis was performed after combining data from Quintana et al. (n = 21; Transplantation February 2015) to determine a PLA2R-Ab concentration which could predict rMN. Six of 16 (37%) patients had biopsy-proven rMN at a median of 3.2 yr post-transplant. Of these, five of six (83%) had a positive PLA2R-Ab pre-transplant with a median of 82 RU/mL (range = 31-1500). The only patient who had rMN with negative PLA2R-Ab was later diagnosed with B-cell lymphoma. One hundred percent (n = 10) of patients with no evidence of rMN (median follow-up = five yr) had negative pre-transplant PLA2R-Ab. In a combined ROC analysis (n = 37), a pre-transplant PLA2R-Ab > 29 RU/mL predicted rMN with a sensitivity of 85% and a specificity of 92%. Pre-transplant PLA2R-Ab could be a useful tool for the prediction of rMN. Patients with rMN in the absence of PLA2R-Ab should be screened for occult malignancy and/or alternate antigens.

KEYWORDS:

antiphospholipase A2 receptor autoantibody; idiopathic membranous nephropathy; kidney transplantation; recurrent membranous nephropathy

PMID:
26854647
DOI:
10.1111/ctr.12711
[Indexed for MEDLINE]

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