Background: Membranoproliferative glomerulonephritis (MPGN) after renal transplantation is a pattern of injury with heterogenous etiologies. Novel classification of MPGN based on the Immunofluorescence microscopy was reported in recent paper. This study want to have a novel classification of MPGN pattern of injury in renal allograft, and try to find the precise diagnosis and analyze the outcome of these patients.

Methodology: Total 25 receipts received the renal allograft biopsy were selected in this study. The histological changes showed membranoproliferative glomerulonephritis pattern in light microscopy in all patients. The immunofluorescence staining of IgA, IgG, IgM,C3, C1q, C4d. IgG subclass(IgG1,2,3,4) and κ/[lambda] chain were performed in all samples. Most of samples were observed by electronic microscopy to observe the electron dense in glomerular. These patients were diagnosed according to the 2015 Mayo Clinic/Renal Pathology Society consensus report and Banff criteria for transplant glomerulopathy. All the patients were analyzed with survival outcome.

Result: They were separated into Ig/c3 positive group( groug1,n=13)and Ig/c3 negaitive group(group 2, n=12) based on the IF result. The patients have precise diagnosis according to the Ig type, C3,IgG subclass andκ/[lambda] chain staining: C3 glomerulopathy(n=2), IgA-mediated MPGN(n=2), polyclonal IgG -mediated MPGN(n=2), Monoclonal IgG GN (n=5, 4 with Ig3κand 1with Ig3[lambda]) ,HCV associated MPGN(n=1),HBV associated MPGN(n=1). In group 2, these patients has higher DSA(9/12), C4d positive in PTCs(6/12), 10/12 were diagnosed with chronic antibody-mediated rejection(ABMR), 2/12 were diagnosed with TMA.5/12 patients received the electronic microscopy without electron dense in glomerular. The time of impaired renal allograft in group 1 was early than group 2(P=0.013). The survival of renal allograft of group 1 was marginally worse than group 2(P=0.071).

Conclusion:The MPGN pattern injury in renal allograft should be have a precise diagnosis according to the IF staining in order to receive the precise treatment. MPGN with Ig and/or complement always have early onset and poor prognosis. MPGN without Ig and complement was related to the ABMR and TMA, which should be considered as a special type of TG.

CITATION INFORMATION: Wen J, Li X, Zhang M, Xu F, Ni X, Chen J, Tang Z, Liu Z. Novel Classification of Membranoproliferative Glomerulonephritis Pattern of Injury in Renal Allograft Based on Immunofluorescence Microscopy: Precise Diagnosis and Prognosis Analysis. Am J Transplant. 2017;17 (suppl 3).

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