Membranoproliferative glomerulonephritis type I in renal transplantation patients: a single-center study of a cohort of 68 renal transplants followed up for 11 years

Background. To evaluate the long-term outcome of renal transplant patients with membranoproliferative glomerulonephritis (MPGN) type I and the impact of recurrence. Methods. The outcomes of 68 renal transplants performed between 1976 and 2009 in 63 patients with MPGN were compared with those of 136 controls matched for time of transplantation, sex, age, and source of donors. Results. The mean posttransplant follow-up was 131.3 +/- 83.8 months for patients with MPGN and 139.21 +/- 88.7 months for controls. At 15 years, patient survival rates were 76.2% in patients with MPGN and 78.8% in controls (P = ns), whereas pure graft survival rates were 68% in MPGN and 67.9% in controls (P = ns). MPGN recurred in 16 patients (23.5%) 44 +/- 30.3 months after transplant (range, 3.5-105 months). Of recurrent grafts, nine were lost for recurrence within 116.5 +/- 51.36 months, three patients died with functioning kidney, the other 4 grafts are functioning 156.7 +/- 47.5 months after transplantation. Graft survival at 15 years was 73.5% in nonrecurrent and 40.4% in recurrent patients (P = 0.02). Patients with recurrence were younger at diagnosis of MPGN (17.64 +/- 5.02 years vs. 22.9 +/- 9.6 years; P = 0.037) and had low C3 more frequently than nonrecurrent patients (75% vs. 28.8%; P = 0.01). Proteinuria was higher in recurrent patients who lost the graft in comparison with those with functioning graft (7.14 +/- 4.05 vs. 2.86 +/- 1.95; P = 0.02). Conclusions. The long-term patient and graft survival were similar in patients with MPGN and in controls. Recurrence occurred in one-fourth of patients and caused graft loss in 56%. Younger age at diagnosis of MPGN and low C3 during transplantation seems to be predictive of recurrence.