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Kidney Week

Abstract: PO2588

Recurrent Focal Segmental Glomerulosclerosis After Kidney Transplantation: A Single-Center Experience

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Panezai, Muhammad Ajmal, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Yenebere, Priya, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Guirguis, John Kimy Demian, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Mishler, Dennis P., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Adebiyi, Oluwafisayo O., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Yaqub, Muhammad S., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Taber, Tim E., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Sharfuddin, Asif A., Indiana University School of Medicine, Indianapolis, Indiana, United States
Background

Recurrent FSGS (r-FSGS) after Kidney Transplantation has a high risk of graft loss. However, the natural history, clinical predictors, and response to treatment remain unclear.

Methods

We retrospectively reviewed all transplant patients at our institition from 2000-2019 with a diagnosis of FSGS and identified and sub-analyzed all cases of recurrent FSGS cases (r-FSGS).

Results

Out of 198 transplants, there were 22 (11.1%) events of biopsy proven r-FSGS. Demographics of the rFSGS cases are described in the Table. 27% of cases had recurrence within 1 month of transplant. Treatments given for r-FSGS included ACE/ARB (100%), Therapeutic Plasma Exchange (40.9%), Rituximab (36.3%), conversion to Cyclosporin (36.3%) and Steroids (27.2%). 65% of cases had either a partial or complete remission. Mean proteinuria decreased and mean eGFR was improved at 1 year of recurrence (p<0.05). Over a median follow up period of 4.6 years, there was a 59% graft loss with no patient deaths. 31.8% of patients were re-transplanted after initial graft loss of which 42% had recurrence in their re-transplant. As compared to the cases without any recurrence, cases with rFSGS had a significantly lower long-term graft survival (p=0.001). Figure.

Conclusion

Recurrent FSGS continues to be a high risk for graft loss despite a multitude of therapies available.

Demographics & Outcomes of Recurrent FSGS Cases
Mean Age49.7+/-13.9
Gender (M)68.5%
Race (W)68.5%
Living Donor45%
Re-Transplants31%
Pre-Emptive22%
Median Duration to Recurrence202 days
Mean Proteinuria at recurrence / at 1 yr post-recurrence5.3±5.9 / 4.1± 4.9 g/day
Mean eGFR at recurrence / at 1 yr post-recurrence28.5±15.2 / 36.6±21.1 ml/min
Initial IS - ATG/MMF/Tac/Pred72%/100%/100%/13.6%