Recurrent, Non-Recurrent, and De Novo Membranous Nephropathy After Kidney Transplantation: A Systemic Review and Meta-Analysis

ABSTRACT Rationale & Objective Recurrent and de novo membranous nephropathy (MN) are significant complications after kidney transplantation, yet prevalence, risk determinants, and treatment outcomes have not been comprehensively quantified. Study Design Systematic review and meta-analysis Setting & Participants Kidney transplant recipients with native-kidney MN (recurrent or non-recurrent) and recipients with de novo MN. Selection Criteria for Studies PubMed, Scopus, and the Cochrane Library were searched through June 30, 2025; 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.