Incidence and risk factors for recurrent membranous nephropathy after kidney transplantation: a systematic review and meta-analysis

The risk factors for membranous nephropathy (MN) following kidney transplantation remain unclear, mainly attributed to the constrained identification of predictive clinical presentation features. This study aims to conduct a systematic review to analyse the risk factors associated with recurrent MN. Starting from its establishment until March 2023, we conducted a screening of case–control studies focusing on recurrent MN in various databases including PubMed, Embase, Web of Science, Medline, the Cochrane Library, CNKI, Wanfang, CBMdisc and Weipu. The protocol was registered on PROSPERO (CRD42022315448). A meta-analysis was carried out to examine the risk factors for recurrent MN, and statistical analysis was performed using Stata 12.0. This meta-analysis included a total of eight case–control studies with 108 patients with recurrent MN and 298 without recurrence. The results showed the incidence of recurrent MN after kidney transplantation was 34%. A higher rate of recurrent MN detected through surveillance biopsies was observed compared to indication biopsies. Living donor [OR = 1.89, 95%CI (1.12, 3.19), and <i>p</i> = 0.017], anti-phospholipase A2 receptor autoantibody (anti-PLA2R) levels before transplantation [OR = 10.16, 95%CI (3.16, 32.62), and <i>p</i> &lt; 0.001] and a shorter duration of dialysis [weighted mean difference (WMD) = −14.36 mo, 95%CI (-24.60, −4.13), and <i>p</i> = 0.006] were associated with a risk for recurrent MN; induction immunosuppression [OR = 0.24, 95%CI (0.10, 0.58), and <i>p</i> = 0.001] and tacrolimus use [OR = 0.23, 95%CI (0.09, 0.61), and <i>p</i> = 0.003] were protective factors for recurrent primary MN, whereas sex, age, time from MN to end-stage renal disease (ESRD), re-transplantation, and race (white) were not associated with recurrent MN. Recurrence of MN persists with a high rate. These factors should be carefully evaluated in clinical decision-making, encompassing living donor selection, pre-transplant anti-PLA2R levels, dialysis, choice of induction immunosuppression, and tacrolimus use.

肾移植后膜性肾病（membranous nephropathy, MN）的危险因素目前仍未明确，主要原因在于预测性临床表现特征的识别存在局限。本研究旨在开展系统综述，分析复发性膜性肾病的相关危险因素。本研究自建库起至2023年3月，在PubMed、Embase、Web of Science、Medline、Cochrane图书馆、CNKI、万方、CBMdisc及维普等多个数据库中，针对复发性膜性肾病的病例对照研究进行了筛选。研究方案已在PROSPERO平台注册（CRD42022315448）。本研究采用Stata 12.0软件进行统计分析，开展荟萃分析以探究复发性膜性肾病的危险因素。本次荟萃分析共纳入8项病例对照研究，包含108例复发性膜性肾病患者及298例未复发患者。结果显示，肾移植后复发性膜性肾病的发生率为34%。通过监测活检检出的复发性膜性肾病比例高于诊断性活检。活体供肾[比值比（OR）=1.89，95%置信区间（CI）(1.12, 3.19)，P=0.017]、移植前抗磷脂酶A2受体自身抗体（anti-PLA2R）水平[OR=10.16，95%CI(3.16, 32.62)，P<0.001]以及较短的透析时长[加权均数差（WMD）=-14.36个月，95%CI(-24.60, -4.13)，P=0.006]与复发性膜性肾病的发病风险相关；诱导免疫抑制治疗[OR=0.24，95%CI(0.10, 0.58)，P=0.001]及他克莫司使用[OR=0.23，95%CI(0.09, 0.61)，P=0.003]则是复发性原发性膜性肾病的保护因素。而性别、年龄、从膜性肾病发展至终末期肾病（end-stage renal disease, ESRD）的时长、再次肾移植及种族（白人）与复发性膜性肾病无显著关联。复发性膜性肾病的复发率仍处于较高水平。临床决策中应谨慎评估上述相关因素，包括活体供肾选择、移植前anti-PLA2R水平、透析情况、诱导免疫抑制治疗方案选择以及他克莫司的使用。