Copyright ©The Author(s) 2017.
World J Transplant. Dec 24, 2017; 7(6): 285-300
Published online Dec 24, 2017. doi: 10.5500/wjt.v7.i6.285
Table 1 Prevalence of the de novo vs recurrent membranoproliferative glomerulonephritis according to the new membranoproliferative glomerulonephritis pathological classification depending on the mechanism of glomerular injury instead of deposits distribution[14,59]
No.MPGN subtypePathological criteriaRecurrent MPGNDe novo MPGN
1ICGN (immune complex-mediated GN)Contains immune complexes + complement compoundsMore common (most of the recurrent cases are ICGN)Reported (3.25%)
2CGN (complement-mediated GN)Contains complement compounds onlyLess prevalent (change from one type to another)Not reported (Ponticelli et al[14], 2014)
Table 2 Case reports in the literatures on de novo proliferative glomerulonephritis with monoclonal IgG deposits in renal allografts
CaseAge at diagnosisGenderOnset time (mo)Type of IgG depositsC1q depositionNative kidney diseasePattern of glomerular injuryMonoclonal gammopathyRef.
124M43IgG3κN/AT1DMMPGNNoneAlbawardi et al[64] (2011)
268F156IgG1κN/APKDMPGNNoneAlbawardi et al[64] (2011)
338F72IgG3κ1+T1DMMesGN or ECN/AHussain et al[72] (2017)
461F98IgG3κC1qMPGNECNoneAl-Rabadi et al[73] (2015)
540F132IgG3κN/AMPGNMPGNNoneAl-Rabadi et al[73] (2015)
646M49IgG1κ1+FSGSMesGNN/ALi et al[77] (2017)
769M6IgG3κ1+Obesity (FSGS?)MPGNN/AMerhi et al[75] (2017)
Table 3 Main characteristics of the more frequent de novo glomerulonephritis after transplantation (minimal change disease, nephrotic syndrome, membranous nephropathy, membranoproliferative glomerulonephritis, hepatitis C virus, IgAN)
DiseasePresentationTime of onsetDifference with native GNTreatmentPrognosis
MNProteinuria sometimes in nephrotic rangeLate after transplantAssociated with trans-plant complications; IgG1 deposits instead of IgG4No specific treatmentSlowly progressive
MPGNProteinuria, hematuria, NS, nephritic sedimentMonths or years after transplantOften associated with HCV, or with other diseasesSteroids + cytotoxic drugs if crescentic GN (?)Slowly progressive; poor with many crescents.
FSGSProteinuria, rarely in nephrotic rangeMonths or years after transplantNS is rare; signs of rejection or CNI toxicity at biopsyRemoval of associated eventsUsually poor, particularly in collapsing GN
MCDNSEarly after transplantMild mesangial sclerosis, hypercellularitySteroidsGood
Table 4 The risk of recurrence of de novo glomerulonephritis after retransplantation is unknown
Disease Indications to retransplant
MNIn view of the slow progression, there is no contraindication to retransplant
MPGNThe risk of recurrence is high in carriers of HCV, active autoimmune disease, or monoclonal gammopathy. These risk factors should be removed or inactivated before retransplant
FSGSIf FSGS was caused by calcineurin inhibitor or mTOR inhibitor toxicity, there is no contraindication to retransplant, but the dosage of the offending drug should be minimized. If FSGS was associated with AMR, the risk of recurrence is increased. Circulating antibodies should be removed before retransplant
Collapsing nephropathyRisk of recurrence is probably high. Antiviral and/or removal of circulating AB before retransplant are recommended according to the possible role played by virus infection or AMR in the 1st transplant
MCDIn view of the favorable prognosis, there is no contraindication to retransplant
IgANNo contraindication to retransplant