BACKGROUND: Recurrence of nephrotic syndrome (NS) after renal transplantation for primary focal segmental glomerulosclerosis (FSGS) is a frequent and still unpredictable complication. However, risk factors for recurrence have not yet been clearly identified. METHODS: Data from 33 patients who underwent 35 renal transplantations for FSGS in two French centres are reported. RESULTS: Recurrent NS occurred in 12 transplant recipients (34%). A significantly higher number of patients in the group with recurrence (R group) compared with the group without recurrence (NR group) received cyclosporine for FSGS treatment before transplantation (83.3% vs 43.4%, P<0.02). Donors of R group recipients were significantly older than those of the non-NR group recipients (42.8 years vs 35 years, P<0.05). A higher number of patients from the R group required post-transplantation dialysis (33.3% vs 17.4%, P = 0.002). Surprisingly, acute rejection occurred more frequently in patients of the NR group compared with the R group, although the difference was not significant. Among the 12 patients with NS relapse, 9 were treated with plasmapheresis. Graft loss related to recurrence occurred in 6 cases. The 5-year graft survival was significantly lower in patients with recurrent NS compared with patients without recurrence (57% vs 82%, P<0.001). CONCLUSION: This study confirms the benefit to identify in the future clinical or biological predictive risk factors for NS recurrence after renal transplantation. It also indicates that donor age is a reliable risk factor for recurrence in adult recipients and suggests for the first time a possible opposite relationship between recurrent FSGS and acute rejection.
BACKGROUND: Recurrence of nephrotic syndrome (NS) after renal transplantation for primary focal segmental glomerulosclerosis (FSGS) is a frequent and still unpredictable complication. However, risk factors for recurrence have not yet been clearly identified. METHODS: Data from 33 patients who underwent 35 renal transplantations for FSGS in two French centres are reported. RESULTS: Recurrent NS occurred in 12 transplant recipients (34%). A significantly higher number of patients in the group with recurrence (R group) compared with the group without recurrence (NR group) received cyclosporine for FSGS treatment before transplantation (83.3% vs 43.4%, P<0.02). Donors of R group recipients were significantly older than those of the non-NR group recipients (42.8 years vs 35 years, P<0.05). A higher number of patients from the R group required post-transplantation dialysis (33.3% vs 17.4%, P = 0.002). Surprisingly, acute rejection occurred more frequently in patients of the NR group compared with the R group, although the difference was not significant. Among the 12 patients with NS relapse, 9 were treated with plasmapheresis. Graft loss related to recurrence occurred in 6 cases. The 5-year graft survival was significantly lower in patients with recurrent NS compared with patients without recurrence (57% vs 82%, P<0.001). CONCLUSION: This study confirms the benefit to identify in the future clinical or biological predictive risk factors for NS recurrence after renal transplantation. It also indicates that donor age is a reliable risk factor for recurrence in adult recipients and suggests for the first time a possible opposite relationship between recurrent FSGS and acute rejection.
Authors: Therese C Jungraithmayr; Katrin Hofer; Pierre Cochat; Gil Chernin; Gerard Cortina; Sonja Fargue; Paul Grimm; Tanja Knueppel; Andreas Kowarsch; Thomas Neuhaus; Philipp Pagel; Karl P Pfeiffer; Franz Schäfer; Ulf Schönermarck; Tomas Seeman; Burkhard Toenshoff; Stefanie Weber; Michelle P Winn; Johannes Zschocke; Lothar B Zimmerhackl Journal: J Am Soc Nephrol Date: 2011-02-25 Impact factor: 10.121
Authors: Audrey Uffing; Maria José Pérez-Sáez; Marilda Mazzali; Roberto C Manfro; Andrea Carla Bauer; Frederico de Sottomaior Drumond; Michelle M O'Shaughnessy; Xingxing S Cheng; Kuo-Kai Chin; Carlucci G Ventura; Fabiana Agena; Elias David-Neto; Juliana B Mansur; Gianna Mastroianni Kirsztajn; Helio Tedesco-Silva; Gilberto M V Neto; Carlos Arias-Cabrales; Anna Buxeda; Mathilde Bugnazet; Thomas Jouve; Paolo Malvezzi; Enver Akalin; Omar Alani; Nikhil Agrawal; Gaetano La Manna; Giorgia Comai; Claudia Bini; Saif A Muhsin; Miguel Carlos Riella; Silvia R Hokazono; Samira S Farouk; Meredith Haverly; Suraj Sarvode Mothi; Stefan P Berger; Paolo Cravedi; Leonardo V Riella Journal: Clin J Am Soc Nephrol Date: 2020-01-23 Impact factor: 8.237