Long-term outcome of renal transplantation in adults with focal segmental glomerulosclerosis

Abstract

Summary Little information is available about the long‐term results of kidney transplantation in adults with focal segmental glomerulosclerosis (FSGS). The outcomes of 52 renal transplants performed between 1988 and 2008 in 47 adults with FSGS were compared with those of 104 matched controls (median follow‐up 93.4 vs. 109.4 months respectively). At 15 years, patient survival was 100% and graft survival 56% in FSGS patients vs. 88.3% and 64% respectively in controls (P = NS). FSGS recurred in 12 out of 52 grafts (23%) and led to graft failure in seven within 10 months (median). In the other five cases, proteinuria remitted and grafts are functioning 106 months (median) after transplantation. A second recurrence developed in five out of eight re‐transplanted patients (62.5%) who lost their first graft because of recurrence; only one graft was lost. Patients with recurrence were more frequently male subjects (83% vs. 40%, P = 0.02), younger at diagnosis of FSGS (16.3 ± 6.8 vs. 24.1 ± 11.5 years, P = 0.03) and of younger age at transplantation (28.4 ± 7.8 vs. 35.8 ± 12.2 years, P = 0.05). Treatment with plasmapheresis plus ACE inhibitors achieved either complete or partial remission in 80% of the cases. Long‐term patient and renal allograft survivals of adults with FSGS were comparable to those of controls. Recurrence was more frequent in young patients and in patients who lost a previous graft from recurrence. Graft loss resulting from a second recurrence is lower than expected.

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“…20 Similarly, Moroni and associates showed that the incidence of acute and chronic rejection was not higher in patients with focal segmental glomerulosclerosis or idiopathic membranous nephropathy than in those with other causes of end-stage renal disease. 21 The same results were obtained by Vega and associates who found no differences in rate of acute rejection episodes between kidney transplant recipients who had polycystic kidney disease and the control group, 22 with this finding also supported by Kute and associates. 23 Regarding recurrence of original kidney disease, our study showed a statistically significant difference in the 4 groups regarding the incidence of recurrence, most commonly occurring with glomerular disorders.…”

An Important Problem: Posttransplant Focal Segmental Glomerulosclerosis Recurrence and Plasmapheresis

“…Moroni et al (31) obtained good results with plasmapheresis treatment in their study on FSGS patients. They found that the prophylactic treatment of plasmapheresis prior to transplantation decreased the incidence of recurrence to 26% versus 54% in controls.…”

Efficacy of the Combination of Immunoadsorption and Rituximab for Treatment in a Case of Severe Focal and Segmental Glomerulosclerosis Recurrence after Renal Transplantation

“…The recurrence of FSGS can lead to the loss of grafts in more than 50% of the transplanted patients [11]. Preemptive plasmapheresis may decrease the incidence of FSGS recurrence [12].…”