Abstract
Membranous nephropathy (MN) post-renal transplant can present as a recurrent or de novo disease, often impacting graft outcomes. We retrospectively analyzed 530 allograft biopsies over 10 years, identifying five MN cases (∼1%): four de novo (0.8%) and one recurrent. Among the former, 75% had concurrent antibody-mediated rejection (AMR); serum anti-PLA2R and tissue PLA2R were detected in 25%. All patients received plasmapheresis and low-dose intravenous immunoglobulin, with one requiring rituximab. Two patients stabilized, one experienced graft loss, and one attained complete remission. The recurrent MN case presented 10 years post-transplant and partially responded to rituximab. AMR influenced prognosis, with a 33% graft loss rate in de novo MN. Individualized treatment based on etiology, particularly targeting rejection, may improve outcomes. The study highlights the need for early diagnosis and personalized management in post-transplant MN.