Table 2.
Clinical features at time of recurrence and clinical course for recurrent (1–18) patients.
| Recurrence | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Patient | Recurrence | Pre-Tx Ab / level by WB | Time (mos) | Urine Protein (mg/day) | Ab | Tissue staining for PLA2R** | Treatment with RTX | Change in Ab levels post-Tx and/or RTX | Clinical condition at last follow-up including response to RTX, rejections, last biopsy findings, most recent proteinuria, ESRD and/or death |
| 1 | Y | NEG | 0.5 | 2312 | NEG | NEG | YES | NEG post-Tx | CR, stage IV deposits EM |
| 2 | Y | NEG | 68 | 512 | NEG | NEG | YES | NEG post-Tx | CR, neg IF/stage I-II deposits EM |
| 3 | Y | NEG | 4 | 205 | NEG | NEG | YES | NEG post-Tx | PR, relapsedtwice more, active disease (proteinuria 2600 mg/24hrs) with additional RTX planned |
| 4 | Y | NEG | 33 | 1278 | NEG | NEG | YES | NEG post-Tx | Positive cross-match Tx, NR to RTX, progressed to ESRD, death 7 years post-Tx |
| 5 | Y | POS/3 | 0.3 | 217 | POS/0.5* | POS | YES | POS post-Tx, NEG after 2nd RTX | See Figure 4. |
| 6 | Y | POS/2 | NA¥ | 2099¥ | NEG¥ | NA | YES | NEG post-Tx | PR, proteinuria 700 mg/day, no follow-up biopsies |
| 7 | Y | POS/2 | 5 | 930 | POS/2 | NA | YES | POS post-Tx, NEG after RTX | CR, stage IV deposits EMwith negative PLA2R tissue staining on later biopsy. |
| 8 | Y | POS/3 | 3 | 148 | POS/3 | POS | YES | POS post-Tx, NEG after 1st RTX dose then POS again. NEG post 2nd RTX dose | See Figure 5. |
| 9 | Y | NA | 5 | 2296 | POS/2 | POS | YES | POS post-Tx, NEG after RTX | CR, stage IV deposits EM |
| 10 | Y | POS/2 | 0.5 | 265 | POS/0.5 | POS | YES | POS post-Tx, NEG after RTX, then POS again | CR initially, now with active disease on biopsy with proteinuria 300 mg/day |
| 11 | Y | POS/3 | 3 | 554 | NEG | POS | YES | NEG post-Tx | See Figure 2. |
| 12 | Y | POS/3 | 4 | 1544 | NA€ | POS | NO | NEG post-Tx | Increased MMF dose -> CR, no deposits, neg PLA2R on subsequent biopsy |
| 13 | Y | POS/2 | 24 | 2082 | NEG | POS | NO | NEG post-Tx | Developed ACR, allograft loss, then 2nd txp withundetectableanti-PLA2R. 2y later without clinical or histology recurrence. Neg biopsy staining for PLA2R. |
| 14 | Y | POS/2 | 54 | 508 | NEG | POS | NO | POS post-Tx, then NEG | Stage III deposits/pos PLA2R on recent biopsy. |
| 15 | Y | POS/2 | 2.5 | 345 | NEG | NA | NO | NEG post-Tx | See Figure 3. |
| 16 | Y | NEG | 3 | 1075 | NEG | NEG | NO | NEG post-Tx | Proteinuria 460 mg/day, ill-defined deposits on EM |
| 17 | Y | NEG | 2.5 | 99 | NEG | NEG | NO | NEG post-Tx | Proteinuria 490 mg/day. |
| 18 | Y | NEG | 4 | 338 | NEG | POS | NO | NEG post-Tx | Historical POS Ab prior toprevious Tx. In this 2nd Tx Persistent undetectable Ab with positive PLA2R staining. proteinuria 100 mg/day |
As tissue was not available on all patients from the biopsy with first recurrence, if PLA2R staining was ever positive in setting of other features of recurrent MN post-Tx, it is listed as (+).
PR is defined as proteinuria ≤ 3.5 g/24h; CR equals proteinuria ≤ 0.3g/24h.
No antibody at time of recurrence, received RTX for AMR and Ab immediately after RTX treatment positive,
No protocol biopsies available, only biopsy is at time of clinical MN recurrence at 120 months, values provided for 120 month visit.
No serum available at time of recurrence, all subsequent Abs negative.
WB = western blotting, NEG = negative, POS = positive/semiquantitative Ab by Western blot, NA = not available, mos = months, Ab = anti-PLA2R antibody, RTX = rituximab, CR = complete response, PR = partial response, NR = no response, EM = electron microscopy, AMR = acute antibody-mediated rejection, ACR = Acute cellular rejection, MMF = mycophenolate mofetil.