Role of transplant induction therapy on recurrence rate of focal segmental glomerulosclerosis

Abstract

Individuals with focal segmental glomerulosclerosis (FSGS) are at risk for recurrence of disease following renal transplantation. The rate of recurrence has been estimated to range from 20% to 30%. The factors associated with an increased probability of recurrence are not known, although the rapidity of progression of disease, age at onset, and the presence of diffuse mesangial proliferation in the native kidney have all been implicated. We analyzed the data from 35 patients with FSGS who received 37 renal transplants at this institution between October 1968 and December 1997. Recurrence was diagnosed by the development of nephrotic-range proteinuria and a transplant biopsy compatible with the diagnosis. Sixteen recurrences were noted, with an overall recurrence rate of 43%. The risk of recurrence was associated with the use of antilymphocytic serum (ALS) for initial induction therapy; being 11% in those who received no induction therapy versus 53% in those who received ALS. Furthermore, in the latter group, the rate of recurrence was 88% in those who received antithymocyte globulin (ATGAM) versus 40% in those who received Minnesota antilymphocytic globulin. Factors such as race, sex, age at time of diagnosis, rapidity of progression to end-stage renal disease (ESRD), response to alkylating agents and/or cyclosporin therapy prior to ESRD, age at time of transplant, donor source, and triple or double immunosuppressive therapy did not appear to have an effect on the rate of recurrence. We conclude that induction therapy with ALS at time of transplantation increases the risk of recurrence of FSGS following renal transplantation.

Recurrent focal glomerulosclerosis in pediatric renal allografts: the Miami experience

“…Post-transplant recurrence of FSGS continues to have a high prevalence rate, estimated to range from 20% to 50% and appears to be increasing in some centers [16,17]. Raafat et al [16] first reported a significant increase in FSGS recurrence from 11% in patients without induction therapy to 53% and 88%, respectively, in those treated with ALG and anti-thymocyte polyclonal antibody (AT-GAM).…”

Recurrent focal segmental glomerulosclerosis after kidney transplantation

“…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.…”

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

“…There does not appear to be any consistent effect of gender (282,286), the type of prophylactic immunosuppression used (276,277,279) or the time spent on renal replacement therapy before transplantation (276). In one uncontrolled study the use of antibody induction therapy was associated with a higher incidence of recurrent FSGS (287). There is also a hereditary form of FSGS (294); in this form, FSGS does not appear to recur as often after transplantation (294,295).…”