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Abstract: PO1532

Long-Term Outcomes of Patients with Focal and Segmental Glomerulosclerosis Treated with Tacrolimus

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Srikantharajah, Mukunthan, Imperial College Healthcare NHS Trust, London, London, United Kingdom
  • Connor, Thomas Michael, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, United Kingdom
  • Levy, Jeremy B., Imperial College Healthcare NHS Trust, London, London, United Kingdom
  • McAdoo, Stephen Paul, Imperial College Healthcare NHS Trust, London, London, United Kingdom
  • Griffith, Megan, Imperial College Healthcare NHS Trust, London, London, United Kingdom
Background

Tacrolimus (TAC) is used to treat Focal and Segmental Glomerulosclerosis (FSGS). Prolonged treatment is often required and there is little data on long-term outcomes.

Methods

This is a retrospective study of 29 patients who received TAC as first line immunosuppression for nephrotic syndrome (NS) secondary to FSGS from December 2007- January 2020 at our institution.

Results

Mean follow up was 59.6 months (12– 144). The mean age at diagnosis was 42 years (range 18-85). 52% were Male. 59% were White, 10% Black, 21% Asian, 3% Chinese, 7% Other. Baseline mean eGFR was 64.4ml/min (18-90).

23/29 (79%) obtained complete (CR) or partial remission (PR) of NS, at a mean time of 5.09 months (range 1-31 months). 6/29 (21%) did not enter remission with TAC. 2/6 subsequently achieved remission with CyP and prednisolone/rituximab.

7/23 (30%) patients who achieved remission with TAC had at least one relapse. 4/7 after stopping TAC, 1/7 during TAC wean and 2/7 with therapeutic TAC levels. 4/7 were treated by restarting or increasing TAC, 1/7 also had steroids added, 1/7 received rituximab (achieving remission) and 1/7 was not further treated with immunosuppression. 4/4 restarted with TAC monotherapy reachieved remission. 16/23 (70%) patients did not relapse and 7 of these remain off TAC and in remission (mean follow up of 92.6 months).

At 1 year, the mean eGFR was 67.4 ml/minute (21-90). 1/29 patient developed end-stage kidney disease (ESKD) at 2 months. This patient had not responded to TAC.

16 patients have 5-year-follow up. The mean eGFR was 66.5 ml/minute (11-90). 1 further patient developed ESKD (this patient had not responded to TAC nor subsequent immunosuppression).

4 patients have 10-year follow-up. The mean eGFR was 80.8 ml/minute (67-90). 3 further patients developed ESKD. 1/3 had achieved PR, 1/3 had achieved CR but had multiple relapses despite re-treatment and 1/3 had CR but defaulted from follow up, presenting with ESKD 6 years later.

Conclusion

The long-term data from this study suggests tacrolimus can be effective in both achieving and maintaining remission of NS in FSGS. CR is associated with good long-term outcomes in most patients although relapse can occur and long term careful follow up is required. Non-responders have a worse outcome, although some patients do respond to alternative immunosuppression.