Post Transplant Membranous Nephropathy: A 10-year Single-Centre Experience

Membranous nephropathy (MN) post-renal transplant can present as a recurrent or <i>de novo</i> disease, often impacting graft outcomes. We retrospectively analyzed 530 allograft biopsies over 10 years, identifying five MN cases (∼1%): four <i>de novo</i> (0.8%) and one recurrent. Among the former, 75% had concurrent antibody-mediated rejection (AMR); serum anti-PLA2R and tissue PLA2R were detected in 25%. All patients received plasmapheresis and low-dose intravenous immunoglobulin, with one requiring rituximab. Two patients stabilized, one experienced graft loss, and one attained complete remission. The recurrent MN case presented 10 years post-transplant and partially responded to rituximab. AMR influenced prognosis, with a 33% graft loss rate in <i>de novo</i> MN. Individualized treatment based on etiology, particularly targeting rejection, may improve outcomes. The study highlights the need for early diagnosis and personalized management in post-transplant MN.