Abstract: SA-PO534
Recurrent FSGS in Renal Transplantation: A Single Centre Experience
Session Information
- Immunosuppression, Disease Recurrence, and Malignancy
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Glomerular
- 1005 Clinical Glomerular Disorders
Authors
- Antonelou, Marilina, University College London, Centre For Nephrology, London, United Kingdom
- sadeghi-alavijeh, Omid, University College London, Centre For Nephrology, London, United Kingdom
- Gale, Daniel P., University College London, Centre For Nephrology, London, United Kingdom
- Jones, Gareth L, Royal Free London NHS Trust, London, United Kingdom
- Salama, Alan D., University College London, Centre For Nephrology, London, United Kingdom
Background
Renal transplantation in patients with Focal segmental glomerulosclerosis (FSGS) is often complicated by disease recurrence which is associated with poor outcome. There are no reliable tests to predict recurrence of FSGS after transplantation. The aim of this study was to evaluate if clinical criteria can identify patients at high risk for recurrent disease.
Methods
Retrospective review of patients diagnosed with FSGS who received a renal transplant in our centre between 1995 and 2017. The diagnosis of primary FSGS was based on a native renal biopsy or unexplained proteinuria and a family history of kidney disease. Recurrence of FSGS was defined as the occurrence of proteinuria, greater than 100 mg/mmol after transplantation with histological evidence of FSGS.
Results
We identified 99 patients with FSGS who received a kidney transplant. Twenty five (25.2%) had biopsy proven recurrent FSGS. The median interval from transplantation to onset of proteinuria was 3.1(1-28)months. A comparison of baseline and follow-up data is shown in Table 1. The median interval between onset of proteinuria and a renal biopsy confirming the diagnosis of recurrent FSGS was 2.7(1.1-4.3) months. Nine patients did not have histological evidence of FSGS on their initial biopsy. None of the 25 patients with recurrent FSGS had a family history of kidney disease. Seven patients had a previous failed transplant, four following FSGS recurrence.
Conclusion
Our data suggest that primary, as opposed to secondary FSGS is a reliable marker of increased recurrence risk in patients with FSGS undergoing renal transplantation. The family history is a useful tool for risk stratification. Close monitoring for proteinuria is important for the initiation of treatment as histological changes might not be present at the early disease stage.
| Recurrence (n=25) | No recurrence (n=74) | p value | |
| Gender (male,%) | 14(56) | 45(60.8) | 0.81 |
| Age of onset of disease (years) | 26(16-43) | 37(30-47) | 0.14 |
| Primary FSGS (n,%) | 24(96) | 57(77) | 0.03 |
| Family history of kidney disease (n,%) | 0 | 9(12.2) | 0.10 |
| Live donor (n,%) Cadaveric donor (n,%) | 8(32) 17(68) | 22(29.7) 52(70.3) | 0.80 |
| Patients with ≥1 failed transplant (n,%) | 7(28) | 5(6.8) | 0.001 |
| Interval from transplantation to last follow-up (LTFU) (years) | 2.9(1.5-15.4) | 8.1(3.1-15.3) | 0.09 |
| Creatinine at LTFU (mmol/L) | 167(123-347) | 139(108-188) | 0.19 |
| RRT dependent at LTFU (n,%) | 10(40) | 6(8.1) | <0.001 |
| Death (n,%) | 5(20) | 8(10.8) | 0.30 |