Abstract: TH-PO0911
Predictors of Kidney Graft Loss Due to Recurrence of FSGS: A United Network for Organ Sharing (UNOS) Analysis
Session Information
- Transplantation: Clinical - Glomerular Diseases, Infections, and Rejection
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Oatley, Zachary, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio, United States
- Shah, Raghav, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio, United States
- Hu, Jieji, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio, United States
- Raina, Rupesh, Akron Children's Hospital, Akron, Ohio, United States
Background
Recurrence of focal segmental glomerulosclerosis (rFSGS) is a significant challenge in patients who receive kidney transplant. Identification of risk factors for rFSGS is crucial for tailoring preventive strategies for disease management.
Methods
Our study used data from the United Network for Organ Sharing registry (overall FSGS n=17665). The primary cohort of this study comprises first-time transplant recipients with rFSGS since 2010 (n=440, avg age 48.0 yrs). Multivariate logistic regression was used to identify risk factors associated with rFSGS. Additionally, cause-specific Cox models were used to assess time to event for graft failure.
Results
Out of 440 patients (282 male, 158 female) with rFSGS, multivariable Cox analysis showed older recipient age (HR 0.991, 95% CI 0.986-0.996, p<0.0005) was identified as protective against rFSGS graft loss. Prolonged cold ischemia time was not significant (Table 1). Living donor transplants (HR 1.246, 95% CI 1.023-1.519, p=0.029), rituximab induction (HR 1.552, 95% CI 1.026-2.348, p=0.037), and dialysis prior to transplant (versus preemptive transplant) (HR 1.426, 95% CI 1.193-1.705, p<0.0005) showed increased rFSGS risk. Significant predictors in Cox analysis were consistent with multivariate logistic regression results (Figure 1).
Conclusion
This cohort represents one of the largest cohorts of rFSGS and outlines key risk factors when assessing a patient’s rFSGS risk. Study limitations include confounding by indication, wherein unmeasured risk factors may influence treatment decisions. This is particularly relevant for rituximab, which is often administered as a preventative therapy.
rFSGS Graft Loss Risk Factors (n=440)
| Risk factor | Hazard ratio | 95% confidence | P-value |
| Protective factors | |||
| Older recipient age (per year increase) | 0.991 | 0.986-0.996 | <0.0005 |
| Prolonged cold ischemia time (per hour increase) | 0.993 | 0.983-1.002 | 0.121 |
| Increased risk factors | |||
| Living donor transplant | 1.246 | 1.023-1.519 | 0.029 |
| Rituximab induction therapy | 1.552 | 1.026-2.348 | 0.037 |
| Used dialysis prior to transplant vs pre-emptive transplant | 1.426 | 1.193-1.705 | <0.0005 |