Abstract: PO2588
Recurrent Focal Segmental Glomerulosclerosis After Kidney Transplantation: A Single-Center Experience
Session Information
- Transplant Complications: Glomerular Disease and Genetics
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
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 Age | 49.7+/-13.9 |
Gender (M) | 68.5% |
Race (W) | 68.5% |
Living Donor | 45% |
Re-Transplants | 31% |
Pre-Emptive | 22% |
Median Duration to Recurrence | 202 days |
Mean Proteinuria at recurrence / at 1 yr post-recurrence | 5.3±5.9 / 4.1± 4.9 g/day |
Mean eGFR at recurrence / at 1 yr post-recurrence | 28.5±15.2 / 36.6±21.1 ml/min |
Initial IS - ATG/MMF/Tac/Pred | 72%/100%/100%/13.6% |