Clinical features and outcomes of kidney transplant recipients with focal segmental glomerulosclerosis recurrence

Abstract

Aim Focal segmental glomerulosclerosis recurs in up to 30% and up to 80% of adult and pediatric kidney transplant recipients, respectively. There is no standard of care treatment. The purpose of this study was to evaluate clinical characteristics, treatments and outcomes of patients with focal segmental glomerulosclerosis recurrence (FSGSr). Methods This was a retrospective single‐center cohort study including FSGSr patients treated with plasmapheresis (PP) and combinations of high dose steroids, cyclosporine and rituximab. Results Among 61 patients included in this analysis the median time to diagnosis was 19 days. The incidence of first biopsy‐confirmed FSGSr was 18% reaching 52.4% with follow‐up biopsies. During PP treatment 54% of the patients developed infectious complications. PP was discontinued in 37% of patients due to treatment failure (no remission or graft loss) and in 26% due to an adverse event. All patients who discontinued PP due to adverse event did not show clinical response or lost the allograft. The incidence of acute rejection was 34.4%. The incidences of partial and complete remissions were 16.4% and 27.8%, respectively. Overall 6‐years patient and graft survivals were 90.7% and 64.5%, respectively. Conclusion This analysis confirms the low, variable and unpredictable rate of FSGSr remission, inconsistencies among available therapeutic options and its high rate of adverse events, and the negative impact on graft survival.

Focal Segmental Glomerulosclerosis Superimposed on Transplant Glomerulopathy: Implications for Graft Survival

“…The levels of proteinuria and serum creatinine and the time from transplantation to biopsy diagnosis of FSGS in our study were similar to those in Cosio’s study. However, compared with recurrent FSGS which usually occurs within a few days or months post-transplantation and presents with nephrotic-range proteinuria [17-20], TG patients with FSGS were diagnosed much later after kidney transplantation and had relatively less proteinuria.…”

Multiple-target Therapy for Posttransplant Focal Segmental Glomerulosclerosis

“…Notably, this response rate did not exhibit improvement with the addition of high-dose steroids. 8 In 2009, in a nonrandomized pilot trial, Canaud et al 9 reported that the use of a "multiple-target therapy," consisting of high-dose intravenous cyclosporine (CsA), prednisone, and PP for a period of 9 mo, achieved CR in 90% of the KTRs with a favorable safety profile. This study sought to confirm the efficacy and safety of this therapeutic strategy using an independent cohort of patients.…”