Transmitted donor-derived glomerular diseases in the allograft kidney are rare, especially when encountered in an allograft from a living donor. To date, only individual reports of donor-derived membranous nephropathy (MN) have been described. In this report, we present a case of MN discovered in a postreperfusion biopsy of a living-donor allograft. A follow-up biopsy 3 weeks later demonstrated persistent deposits. Thirteen months posttransplant, the recipient showed mildly worsening proteinuria but stable kidney function. To further our understanding of this exceedingly rare complication, we share our experience with 7 additional in-house cases together with 6 cases described in the literature to date. A minority of the donors were living. Most donors did not exhibit significant proteinuria illustrating how predonation screening could potentially miss donor-derived MN. Reactivity for phospholipase A2 receptor and thrombospondin type 1 domain containing 7A were negative in all stained cases. On follow-up, recipients variably exhibited slow resolution of the immune deposits, variable degrees of proteinuria (mainly subnephrotic), and no significant impairment of kidney function. Donor-derived MN is rare, phospholipase A2 receptor-negative, and can still be encountered in living donors despite rigorous screening. This report provides a brief examination of the pathology, clinical, and laboratory features of such patients involved.

中文翻译：

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同种异体移植肾中供体来源的膜性肾病：一种罕见但可能被低估的并发症


同种异体移植肾中传播的供体来源的肾小球疾病很少见，尤其是在活体供体的同种异体移植物中遇到时。迄今为止，仅描述了供体来源的膜性肾病 （MN） 的个体报告。在本报告中，我们介绍了一例在活体供体同种异体移植物再灌注后活检中发现的 MN 病例。3 周后的随访活检显示持续性沉积。移植后 13 个月，受者蛋白尿轻度恶化，但肾功能稳定。为了进一步了解这种极其罕见的并发症，我们分享了另外 7 个内部病例以及迄今为止文献中描述的 6 个病例的经验。少数捐献者还活着。大多数供体没有表现出明显的蛋白尿，这说明了捐献前筛查如何可能遗漏供体来源的 MN。在所有染色病例中，磷脂酶 A2 受体和含有 7A 的血小板反应蛋白 1 型结构域的反应性均为阴性。在随访中，受者不同程度地表现出免疫沉积物的缓慢消退、不同程度的蛋白尿（主要是亚肾病性），并且没有明显的肾功能损害。供体来源的 MN 很少见，磷脂酶 A2 受体阴性，尽管经过严格筛选，但仍可在活体供体中发现。本报告简要介绍了此类受累患者的病理学、临床和实验室特征。