Kidney transplantation for primary focal segmental glomerulosclerosis: Outcomes and response to therapy for recurrence

Latonya J. Hickson, Manish Gera, Hatem Amer, Corey W. Iqbal, Therese B. Moore, Dawn S. Milliner, Fernando G. Cosio, Timothy S. Larson, Mark D. Stegall, Michael B. Ishitani, James M. Gloor, Matthew D. Griffin

Research output: Contribution to journalArticle

103 Scopus citations

Abstract

BACKGROUND.: For a subset of adults and children with primary focal segmental glomerulosclerosis (FSGS), proteinuria and renal dysfunction recur after kidney transplantation (KTx). Predicting recurrence and response to plasmapheresis (PP) or other interventions remains problematic. METHODS.: The prevalence, recurrence rate, outcomes, and treatment responses of patients with FSGS were determined among 1573 KTx recipients. Although 5.0% carried some diagnosis of FSGS, only 1.9% (n≤30) met strict diagnostic criteria for primary FSGS including biopsy-proven FSGS, lack of secondary factors, negative family history, and progression to end-stage renal disease within 10 years. RESULTS.: Of these, 47% had recurrent FSGS compared with 8% of those not meeting strict criteria (P<0.001). Recurrence was more common in children compared with adults (86% vs. 35%, P=0.01). Graft survival was lower for recipients with primary FSGS compared with all others and inferior graft survival was attributable to recurrent FSGS. Fourteen patients received PP preemptively (pre-KTx) or therapeutically (post-KTx) for recurrent disease. Four pediatric patients additionally received anti-CD20 (rituximab) therapy. Of the different treatment approaches, only PP combined with rituximab was associated with prolonged remission of proteinuria. CONCLUSIONS.: The results indicate that patients at high risk for FSGS recurrence can be identified and may benefit from carefully planned peritransplant interventions.

Original languageEnglish (US)
Pages (from-to)1232-1239
Number of pages8
JournalTransplantation
Volume87
Issue number8
DOIs
StatePublished - Apr 27 2009

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Keywords

  • Focal segmental glomerulosclerosis
  • Kidney transplantation
  • Plasmapheresis
  • Recurrent disease
  • Rituximab

ASJC Scopus subject areas

  • Transplantation

Cite this

Hickson, L. J., Gera, M., Amer, H., Iqbal, C. W., Moore, T. B., Milliner, D. S., Cosio, F. G., Larson, T. S., Stegall, M. D., Ishitani, M. B., Gloor, J. M., & Griffin, M. D. (2009). Kidney transplantation for primary focal segmental glomerulosclerosis: Outcomes and response to therapy for recurrence. Transplantation, 87(8), 1232-1239. https://doi.org/10.1097/TP.0b013e31819f12be