Kidney Transplantation for Primary Focal Segmental Glomerulosclerosis: Outcomes and Response to Therapy for Recurrence

Abstract

The results indicate that patients at high risk for FSGS recurrence can be identified and may benefit from carefully planned peritransplant interventions.

Recurrent focal segmental glomerulosclerosis after kidney transplantation

“…A heightened risk of recurrence in white children was also documented in a recent review of UNOS data over the 20-year period of 1988-2008 [12]. The report by Hickson et al [5] is discordant. However, only two African Americans who required a kidney transplant secondary to FSGS were included in that study.…”

“…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]. Hwang et al [8] provide data for the gender of the donor and found a comparable incidence of 36 % with a female donor versus 29 % with a male donor.…”

“…However, in two studies that included only pediatric patients or provided separate data for children, the overall incidence was reported to be 43 and 55 % [5,6]. The review by Huang et al [7] represents one of the largest reports regarding recurrent FSGS and described a much lower incidence of recurrence FSGS compared to other studies (6 %).…”

“…The authors acknowledge that detailed information about clinical and laboratory findings prior to transplant is not available for patients in the database that was used [7]. 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].…”

“…Plasmapheresis Plasma-based treatments, primarily plasmapheresis, have been used as a first-line treatment for FSGS and for recurrent FSGS after transplantation for nearly 20 years [5,[46][47][48][49][50][51][52][53][54][55][56][57][58][59]. The results of select studies performed since the year 2000 with larger numbers of patients are summarized in Table 2.…”