Outcomes After Kidney Transplantation in Antiglomerular Basement Membrane Disease

Introduction

Goodpasture disease, or antiglomerular basement membrane (anti-GBM) disease, is a rare autoimmune disorder that often leads to end-stage kidney disease (ESKD). Although kidney transplantation (KT) is the preferred treatment, concerns exist about disease recurrence and graft outcomes in patients with GBM-associated glomerulonephritis (GBM-GN). This study aimed to evaluate posttransplant outcomes in patients with GBM-GN compared with matched controls.

Methods

This retrospective, multicenter study included 100 patients with anti-GBM who received KT between 2005 and 2023 in 13 French transplant centers, matched with 200 control recipients. We compared the incidence of delayed graft function (DGF), graft failure, relapse, acute rejection, and death between groups and analyzed risk factors using multivariable models.

Results

No significant differences in DGF incidence (22% vs. 19%, P = 0.5), graft survival (87% vs. 88% at 5 years, P = 0.4), or patient survival (93% vs. 89% at 5 years, P = 0.4) were found between patients with GBM-GN and controls. Patients with GBM-GN tended to have lower risk of acute rejection (hazard ratio [HR] = 0.51, 95% confidence interval: 0.25–1.02, P = 0.055). Only 1 patient with GBM-GN (1%) experienced disease relapse. Although patients with GBM-GN were waitlisted and transplanted later than controls, specific transplant timing was not associated with improved outcomes.

Conclusion

KT in patients with GBM-GN offers comparable outcomes to other nephropathies in the current era. Disease relapse is rare, even in the few patients with detectable antibodies pretransplantation. The lower incidence of acute rejection in the GBM-GN group warrants further investigation. These findings support KT as a viable option in patients with GBM-GN, though specific pre- and posttransplant monitoring is advised.