Focal segmental glomerular sclerosis in renal transplant recipients: predicting early disease recurrence may prolong allograft function

Abstract

Recurrence of focal segmental glomerular sclerosis (FSGS) in the allograft following renal transplantation can be graft threatening. To assess risk factors associated with FSGS recurrence, we analyzed 22 patients with FSGS who underwent transplantation between 1996 and 2004. Five patients (Group I, 23%) developed FSGS post-transplantation. Of these patients, 60% had undergone bilateral nephrectomy (BN) for progressive disease compared with none of the patients that were free of recurrence (Group II) (p = 0.0006). Other factors linked with recurrent FSGS were time to first dialysis (Group I: 3.1 +/- 1.1 yr vs. Group II: 11.9 +/- 1.9 yr; p = 0.03), pre-transplant proteinuria (Group I: 7.0 +/- 1.8 g/d vs. Group II: 2.5 +/- 0.7 g/d; p = 0.02), young age at transplantation (p = 0.09) and female sex (Group I: 80% vs. Group II: 24%; p = 0.021). Eighty percent of Group I patients received a living related transplant vs. 24% in Group II (p = 0.021). All grafts continue to function at last follow-up with comparable serum creatinines. Overall, post-transplant FSGS recurrence may be associated with BN, severity of pre-transplant FSGS, female gender, and living donation. These patients should be monitored closely for early recurrence and may benefit from early plasmapheresis to restore and facilitate long-term graft function.

Recurrent focal segmental glomerulosclerosis after kidney transplantation

“…Three studies report data regarding gender and all found an increased incidence in females. Sener et al [10] found a statistically significant difference with only one male compared to 50 % of females having recurrent FSGS. The gender difference in the other two studies is not as striking, but they still report a 29 and 41 % incidence in males and a 36 and 63 % incidence in females [5,8].…”

“…Recurrent FSGS resulted in a loss of the expected living-donor graft survival advantage [16]. In contrast, Sener et al [10] found no adverse effect of recurrent disease on allograft survival in patients with FSGS. A similar finding was also reported by Jungraithmayr in a series of 86 pediatric patients [11].…”

“…Hickson et al [5] provided data for the incidence of recurrent disease for both a clinically based diagnosis of primary FSGS compared to biopsy-proven diagnosis and found the incidence to increase drastically from 55 to 75 % [3]. The majority of studies reported an incidence closer to 25 %; however, these included pediatric and/or adult patients [8][9][10][11]. Trend analysis of data compiled by the United Network for Organ Sharing (UNOS) over the period from 1988-2008 showed an increase in cases of recurrent FSGS by 5.8 % per year [12].…”

Focal Segmental Glomerulosclerosis (FSGS) Recurrence in Kidney Allograft Recipients

“…In Schachter's material recurrence rate was 23% of patients with biopsy proven primary FSGS (55). Sener et al have reported that post-transplant recurrence of FSGS may be associated with bilateral nephrectomy indicated in some patients with catastrophic NS (70). These patients should be monitored closely for early recurrence and may benefit from early PP treatment (70).…”

Bilateral Native Ureteral Ligation Without Nephrectomy in the Management of Kidney Transplant Recipients With Native Proteinuria

“…This may delay diagnosis and treatment which may affect outcome (2). Our program follows a protocol for transplantation of patients with FSGS that includes intensive monitoring for the recurrence of proteinuria after transplantation and plasma exchange in patients suspected of developing recurrent disease.…”