Renal transplant outcomes in primary <scp>FSGS</scp> compared with other recipients and risk factors for recurrence: A national review of the Irish Transplant Registry

Cormican, Sarah; Kennedy, Claire; O’Kelly, Patrick; Doyle, Brendan; Dorman, Anthony; Awan, Atif; Conlon, Peter J.

doi:10.1111/ctr.13152

Cited by 20 publications

(24 citation statements)

References 22 publications

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“…Second transplant after loss from FSGS recurrence in the first transplant has been previously reported as a risk factor associated with increased risk of recurrence . It has also been reported that there is an increased risk of graft failure in adolescents compared to younger children .…”

Section: Discussionmentioning

confidence: 93%

“…Second transplant after loss from FSGS recurrence in the first transplant has been previously reported as a risk factor associated with increased risk of recurrence. 13,14 It has also been reported that there is an increased risk of graft failure in adolescents compared to younger children. 15 In a Korean cohort, Hwang et al 16 found that there was no significant difference in recurrence rates or overall graft survival between adult FSGS recipients and children <15 years.…”

Section: Patient and Allograft Survivalmentioning

confidence: 99%

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Risk factors associated with allograft failure in pediatric kidney transplant recipients with focal segmental glomerulosclerosis

Koh

Martz

Blydt-Hansen

et al. 2019

Pediatric Transplantation

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Background With improved outcomes for children transplanted with FSGS since previous NAPRTCS registry reports, this study re‐evaluates the association of living donation, immunosuppression, and DGF on graft survival. Setting Patients transplanted between 2002 and 2016, comparing FSGS diagnosis vs other glomerular diseases. Methods Primary outcomes were allograft survival and FSGS recurrent‐free graft survival. Potential risk factors were obtained at the time of transplant and up to 30 days post‐transplantation. Analysis considered a priori that DGF may be a proxy for severe FSGS recurrence. Multivariable survival models for outcome were tested for sensitivity without/with DGF to determine features independent of recurrence. Results From the larger cohort of 3010 patients, 5‐year graft survival in children with FSGS (n = 455) was worse (74.3%) compared with other glomerular diseases (87.1%, n = 690) (HR 1.45, P = 0.033). Modeling all glomerular diseases, survival risk was associated with deceased donor (HR 1.83, P = 0.002), re‐transplantation (HR 1.58, P = 0.013), and recipient age (HR 1.06/y, P = 0.002). The living donor advantage was not confirmed in a FSGS model (HR 1.51 for deceased, P = 0.12). DGF was highly associated with graft failure (HR 4.39, P < 0.001) and independent of re‐transplant history but not FSGS diagnosis. Induction agents or primary immunosuppression choices were not associated with survival. Conclusion Graft survival rates have improved since the previous report. Living donor did not predict graft failure, but there remains no survival advantage. DGF was the primary independent predictor for graft loss secondary to FSGS recurrence, consistent with DGF being a proxy for severe recurrent disease.

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Section: Discussionmentioning

confidence: 93%

Section: Patient and Allograft Survivalmentioning

confidence: 99%

Risk factors associated with allograft failure in pediatric kidney transplant recipients with focal segmental glomerulosclerosis

Koh

Martz

Blydt-Hansen

et al. 2019

Pediatric Transplantation

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“…Between 30% and 70% of children with idiopathic FSGS develop recurrent disease after renal transplantation . The onset of FSGS recurrence sometimes occurs within minutes after kidney transplantation.…”

Section: Introductionmentioning

confidence: 99%

“…8 Between 30% and 70% of children with idiopathic FSGS develop recurrent disease after renal transplantation. 2,6,[9][10][11][12][13] The onset of FSGS recurrence sometimes occurs within minutes after kidney transplantation. However, it is generally accepted that the risk of recurrence is not high enough to contraindicate the transplantation procedure.…”

Section: Introductionmentioning

confidence: 99%

European Society of Pediatric Nephrology survey on current practice regarding recurrent focal segmental glomerulosclerosis after pediatric kidney transplantation

Bouts

Veltkamp

Tönshoff

et al. 2019

Pediatric Transplantation

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Introduction Primary FSGS is an important cause of ESRD in children. FSGS recurrence after kidney transplantation is associated with early graft loss. No guidelines for treatment of FSGS recurrence exist. We conducted a survey to gain insight into variation of treatment between centers. Methods A survey was sent to all members of the ESPN on behalf of the “Renal Transplantation” and “Idiopathic Nephrotic Syndrome” working groups. Results Fifty‐nine nephrologists from 31 countries responded, reporting 807 FSGS patients, with 241 (30%) FSGS recurrences after transplantation. Recurrence varied from 0% to 100% between respondents. Native nephrectomy before or during transplantation was performed, respectively, always (37%), never (39%), or on clinical indication (17%). Half of the respondents started preventive treatment before transplantation, using PF (n = 10); R (n = 4); PF or IA, plus R (n = 9); cyclosporine (n = 2); or unknown (n = 4). Immunosuppressive therapy for patients without known mutations consisted of a combination of steroids, tacrolimus/cyclosporine, and MMF, with or without IL‐2R‐blockade in, respectively, 61% and 86% of the respondents. Sixty‐three percent applied a similar regimen to patients with known mutations. FSGS recurrence was treated with PF or IA, plus R by 66% of respondents; 54% observed no response. Complete remission in >50% of patients was reported by 41% of the respondents. Discussion FSGS recurrence after transplantation is common, but varies greatly between centers. We found great variability in preventive and therapeutic treatment regimens. Future research should focus on predisposing factors, including biopsy findings and genetic mutations, and standardized treatment.

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“…Registry data are one way to eliminate reporting bias. In one study of the Irish Transplant Registry, 60.5% of patients developed recurrent FSGS in the first transplant, whereas 86% of patients with a recurrence in the first transplant also recurred in the second, and clearly, recurrent FSGS was associated with high rates of graft failure . In children, up to 12% of patients with end‐stage kidney disease may have FSGS according to the Latin American Registry ALANEPE .…”

mentioning

confidence: 99%

The urgent need for more research on how to treat recurrent focal and segmental glomerulosclerosis

Filler

Restrepo

2018

Pediatric Transplantation

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Renal transplant outcomes in primary FSGS compared with other recipients and risk factors for recurrence: A national review of the Irish Transplant Registry

Abstract: We demonstrate high rates of r-FSGS and describe modest success from with treatments for r-FSGS.

Cited by 20 publications

References 22 publications

Risk factors associated with allograft failure in pediatric kidney transplant recipients with focal segmental glomerulosclerosis

Risk factors associated with allograft failure in pediatric kidney transplant recipients with focal segmental glomerulosclerosis

European Society of Pediatric Nephrology survey on current practice regarding recurrent focal segmental glomerulosclerosis after pediatric kidney transplantation

The urgent need for more research on how to treat recurrent focal and segmental glomerulosclerosis

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