ABSTRACTRationale studies comparing risk factors and outcomes among these groups were eligible for meta-analyses. Data Extraction Study characteristics; demographics; transplant features; outcomes including remission and allograft loss. Analytic Approach Random‐effects meta‐analyses calculated weighted mean differences or pooled odds ratios (ORs) for comparisons between recurrent versus non-recurrent or de novo MN, allograft outcomes, and response to rituximab. Results The included studies comprised a total of 2,259 kidney transplant recipients with recurrent (28%), non-recurrent (61%), or de novo MN (11%). Recurrence prevalence was 39% (95%CI 28–50%) in studies with protocol biopsies versus 25% (95%CI 20–29%) without protocol biopsies (p-value 0.046). Compared with non-recurrence, recurrent MN was linked to older recipient age, shorter dialysis vintage and interval from native MN to dialysis, living-donor grafts, and higher pre-transplant anti-phospholipase A2 receptor. Mycophenolic acid and prednisolone use were protective against recurrent MN. De novo MN carried a higher associated rejection than recurrent MN (OR 2.30, 95%CI 1.16–4.58). Rituximab increased remission odds (OR 4.90, 95%CI 1.70–14.13). Meta-regression demonstrated a significant decline in allograft loss rates over time following MN recurrence. Limitations Substantial heterogeneity and small-study effects in some variables; magnitudes should be interpreted cautiously. Conclusions MN recurs in approximately one-third of recipients. Protocol biopsy should be utilized in recipients with history of native MN. Rituximab emerges as the preferred first-line treatment for recurrent MN.
Phumthian et al. (Sun,) studied this question.