Retransplantation in Patient With Recurrent MPGN?
Is it reasonable to retransplant a patient who lost his graft due to recurrent membranoproliferative glomerulonephritis (MPGN) type 2?

Ayman Refaie, MD

Recurrence of MPGN type 2 is quite frequent, occurring in over 80% of patients, and is characterized by dense deposits in the base membrane as demonstrated by electron microscopy. However, graft failure occurs in less than 50% of patients and especially in those who develop posttransplant nephritic syndrome. Patients with a history of recurrence of MPGN type 2 need to be evaluated for retransplantation with great caution. It is clear that these patients should not be considered for living-related transplantation because of the possibility that the recurrence rate may be even higher from HLA-matched kidney donors. If the recurrence of MPGN type 2 in the first allograft occurred very early posttransplantation and graft loss occurred quite rapidly, the patient may not be a good candidate for retransplantation. However, if the patient had developed an indolent recurrence and had adequate renal function for several years, then the patient should be considered for retransplantation. Patients with severe recurrence of MPGN type 2 from an HLA identical living donor and rapid progression to renal failure can be considered for retransplantation from a cadaver donor, with the hope that with the mismatched kidney the recurrence rate will be lower, or at least the course of the disease in the new graft will be more benign. Fortunately, MPGN type 2 is a rare disease, but it remains a major challenge especially in patients with a history of a recurrence in a previous graft.