Kidney transplantation encounters a significant challenge due to the persistent shortage of donor organs. Membranous nephropathy (MN) is a rare entity among donor-derived glomerular diseases, and its impact on allograft function and long-term survival remains incompletely understood.

Methods: We report two kidney transplants from a donor with early-stage MN. The left kidney recipient developed significant proteinuria and elevated creatinine, with a biopsy confirming acute T cell-mediated rejection and donor-derived MN. Following short-term peritoneal dialysis and intensified immunosuppression, serum creatinine levels progressively declined, leading to a restoration of renal function. The right kidney recipient experienced an uncomplicated postoperative course and maintained stable renal function. 8-month protocol biopsies in both recipients demonstrated partial pathological remission. At the 8-year follow-up post-transplantation, both recipients maintained excellent renal function. Despite the potential risks of proteinuria and dysfunction, and challenges in donor diagnosis associated with MN donor kidneys, our two cases demonstrate excellent long-term graft function (8-year follow-up), even in one recipient who experienced acute rejection that responded to intensified immunosuppression. These observations suggest the potential for carefully selected MN donor kidneys to expand the donor pool, though larger-scale studies are essential given the limitations of a case report.

Conclusions: In these two cases, kidney transplantations from early-stage MN donors exhibited excellent long-term graft function and partial pathological remission. Such results suggest a potential viable strategy to expand the donor pool, contingent upon rigorous clinical oversight and tailored management strategies.