*Purpose: To analyze the clinicopathological characteristics, treatment efficacy and prognosis of proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) in renal allografts from multi-centers in China.

*Methods: We enrolled PGNMID cases confirmed by allograft biopsy from 8 hospitals in China from January 2005 to December 2019, then the clinical and laboratory data were collected and the risk factors associated with prognosis were analyzed in all enrolled cases.

*Results: A total of 13 cases were enrolled. The median follow-up time was 43 months (range: 11-142 months) since kidney transplantation (KTx). Main clinical presentations at diagnosis included hematuria (92%) and proteinuria (100%). Median graft survival was 17 months from time of diagnostic biopsy, and was 49 months from Tx. Only 1 case showed IgGλ stripe through serum immunofixation electrophoresis. Light microscopy displayed MPGN (n=8), MN (n=2), MsGN (n=3). Immunofluorescence (IF) revealed IgG3κ (n=9), IgG3λ (n=2), IgG1κ (n=1) and IgG1λ (n=1). Except for the basic immunosuppressive therapies, partial cases received additional therapies including plasma exchange (n=3), pulse steroid (n=3), IVIG (n=2), bortezomib (n=7), rituximab (n=4). During the follow-up, nine cases progressed to dialysis, of which two cases died of infection. One case had complete response and one case had partial response after intensive therapies. Native kidney biopsy manifesting as MPGN was related to rapid diagnosis and poor prognosis compared to unknow primary glomerular diseaese.

*Conclusions: PGNMID in renal allografts represented mostly MPGN in LM and IgG3κ in IF in Chinese recepients, which progress rapidly once diagnosis. Recepients with primay MPGN should receive surveillance biopsy after KTx.

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