RECURRENCE OF RENAL AMYLOID AND DE NOVO MEMBRANOUS GLOMERULONEPHRITIS AFTER TRANSPLANTATION

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Abstract
Eleven patients with amyloidosis were treated for terminal renal failure by transplantation, receiving 12 cadaver allografts. In 1 patient the amyloidosis was primary; in the remaining 10 it was secondary to a chronic inflammatory disease. All of the patients were subjected to 1 or 2 fine-needle aspiration biopsies of the kidney graft during a followup of 11 to 68 mo. The biopsies of 3 patients, 1 with primary amyloidosis and 2 with ankylosing spondylitis, revealed amyloid recurrence in the graft. These recurrences were diagnosed at 11, 28 or 37 mo., respectively. The risk of amyloid recurrence is thus by no means negligible. No factors determining the development of recurrence were revealed. In 2 additional cases, membranous glomerulonephritis was observed in transplant biopsy. Both of these patients had rheumatoid arthritis as the underlying disease and were treated with Au salts before transplantation. An impaired immune response, related to amyloidosis and/or immunosuppressive therapy, may have favored the formation and deposition of circulating immune complexes.