# Long-term outcomes of kidney transplantation in two recipients from a single membranous nephropathy donor: Case reports and literature review

## TL;DR

Two kidney recipients from a donor with early-stage membranous nephropathy showed excellent long-term graft function, suggesting such donors could help address the organ shortage.

## Contribution

Demonstrates that kidneys from early-stage membranous nephropathy donors can yield successful long-term outcomes with proper management.

## Key findings

- Both recipients maintained excellent renal function at 8 years post-transplantation.
- One recipient recovered from acute rejection with intensified immunosuppression.
- Protocol biopsies showed partial pathological remission in both recipients.

## Abstract

Kidney transplantation encounters a significant challenge due to the persistent shortage of donor organs. Membranous nephropathy (MN) is a rare entity among donor-derived glomerular diseases, and its impact on allograft function and long-term survival remains incompletely understood.

We report two kidney transplants from a donor with early-stage MN. The left kidney recipient developed significant proteinuria and elevated creatinine, with a biopsy confirming acute T cell-mediated rejection and donor-derived MN. Following short-term peritoneal dialysis and intensified immunosuppression, serum creatinine levels progressively declined, leading to a restoration of renal function. The right kidney recipient experienced an uncomplicated postoperative course and maintained stable renal function. 8-month protocol biopsies in both recipients demonstrated partial pathological remission. At the 8-year follow-up post-transplantation, both recipients maintained excellent renal function.

Despite the potential risks of proteinuria and dysfunction, and challenges in donor diagnosis associated with MN donor kidneys, our two cases demonstrate excellent long-term graft function (8-year follow-up), even in one recipient who experienced acute rejection that responded to intensified immunosuppression. These observations suggest the potential for carefully selected MN donor kidneys to expand the donor pool, though larger-scale studies are essential given the limitations of a case report.

In these two cases, kidney transplantations from early-stage MN donors exhibited excellent long-term graft function and partial pathological remission. Such results suggest a potential viable strategy to expand the donor pool, contingent upon rigorous clinical oversight and tailored management strategies.

•Kidneys from donors with membranous nephropathy are potentially suitable for transplantations.•Short-term low-level proteinuria post-transplantation is considered harmless.•Strategic immunosuppression and protocol biopsies are critical for successful kidney transplantation.

Kidneys from donors with membranous nephropathy are potentially suitable for transplantations.

Short-term low-level proteinuria post-transplantation is considered harmless.

Strategic immunosuppression and protocol biopsies are critical for successful kidney transplantation.