Kidney transplantation with a thin membrane nephropathy donor: a case report
Pasilan, 2023 reported this unusual case recently.
Kidney transplant from an identical, or monozygotic, twin usually possesses an excellent immunological match and provides the opportunity to minimise or even avoid immunosuppression toxicity. However, there are concerns regarding disease recurrence among end stage renal disease (ESRD) patients with an unknown aetiology.
Read more about the stages of kidney disease here.
Together with the risk of inherent, familial disease affecting both the organ donors and recipients, more invasive tests such as a pretransplant biopsy are being considered to ascertain renal prognosis.
A 30-year-old female with CKD Stage 5 from an unknown aetiology, with secondary hyperparathyroidism and heart failure, underwent kidney transplantation. Her donor was her identical twin who was well, and had no comorbidities. The recipient had a previous history of blood transfusion.
Immunological workup revealed the following: matched blood type, zero HLA mismatch, negative T-cell tissue crossmatch but with a positive Class I HLA antigen screen. Antibody specificity revealed the presence of donor specific antibodies (DSA).
After workup completion, the patient underwent a right kidney transplant with a preimplantation wedge biopsy on the donor kidney. Immediate graft function was noted post operatively. The wedge biopsy revealed a thin glomerular basement membrane, consistent with thin membrane nephropathy.
The patient was started on immunosuppression and prophylaxis during the duration of the post operative period without any complications. Five months post-transplant, both the recipient and donor maintain an adequate renal function without any signs of allograft rejection.
In this case report, we have demonstrated that TMN may serve as a viable donor for a presumed monozygous twin kidney transplantation. When a live donor with TMN is being considered, a thorough work-up and identification of high-risk features are essential to exclude other progressive renal diseases during the pre-transplant evaluation.
Other resource
CKDEx has more information on thin membrane nephropathy.
Last Reviewed on 26 June 2024
