Abstract: SA-PO1157
Recurrence of Focal Segmental Glomerulosclerosis After Kidney Transplantation in an International, Multicenter Cohort from the TANGO Study
Session Information
- Transplantation: Clinical - Rejection, Recurrent Disease, Incompatibility
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Uffing, Audrey, Brigham and Women''s hospital, Boston, United States
- Cravedi, Paolo, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Riella, Leonardo V., Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Group or Team Name
- TANGO-consortium
Background
Focal segmental glomerulosclerosis (FSGS) recurrence after kidney transplantation is a major risk factor for graft loss. However, the natural history, clinical predictors, and response to treatment remain unclear due to small sample sizes and poor generalizability of single center studies, and disease misclassification in registry-based studies.
Methods
As part of The Post-Transplant Glomerular Disease (TANGO) project, we performed a multicenter, international, retrospective observational study to determine the incidence, predictors and treatment response of recurrent FSGS.
Results
Amongst 11,742 kidney transplant recipients screened for FSGS between 2005-2015, 176 had idiopathic FSGS. FSGS recurred in 57 patients (32%, 95%CI: 25-39%) and 39% of them lost their graft over a median (IQR) of 5 (3.0-8.1) years (Figure 1). Multivariate Cox-regression revealed an increased risk for recurrence with older age at native kidney disease onset (HR 1.37 per decade, 95%CI: 1.09-1.56). Other predictors were white race (HR 2.14, 95%CI: 1.08-4.22), BMI at transplant (HR 0.89 per Kg/m2, 95%CI: 0.83-0.95), and native kidney nephrectomies (HR 2.76, 95%CI: 1.16-6.57). Loss of prior allografts due to FSGS increased the chances of a subsequent recurrence with 45% in a second graft and 100% in a third graft. Plasmapheresis and rituximab were the most frequent treatments (81%). Partial or complete remission occurred in 57% of patients and was associated with better graft survival.
Conclusion
Idiopathic FSGS recurs post-transplant in one-third of cases, increasing by 5-fold the risk of graft loss. Response to treatment significantly improves outcomes but is achieved in only half of cases. Multicenter collaborative efforts such as TANGO allow for the identification of novel risk factors for FSGS recurrence as well as for more precise estimates of recurrence incidence and outcomes.
Funding
- Private Foundation Support