Abstract: TH-PO1219
Recurrence of FSGS After Kidney Transplantation in Pediatric Patients: Outcomes, Treatment Response, and the Role of HLA-DR7
Session Information
- Pediatric Nephrology: CV Health, CKD, AKI, Dialysis, Transplantation, and Health Services Research
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1800 Pediatric Nephrology
Authors
- Koch Nogueira, Paulo C., Hospital Samaritano de Sao Paulo, São Paulo, SP, Brazil
- Feltran, Luciana S., Hospital Samaritano de Sao Paulo, São Paulo, SP, Brazil
- Carvalho, Maria Fernanda Camargo, Hospital Samaritano de Sao Paulo, São Paulo, SP, Brazil
Background
Focal segmental glomerulosclerosis (FSGS) recurrence after pediatric kidney transplantation (pKT) may lead to graft loss. Treatment is not standardized, particularly plasmapheresis (PF) duration and intensity. Previous studies suggest that HLA-DR7 may increase recurrence risk. We analyzed incidence, treatment response, graft outcomes, and the association between HLA-DR7 and recurrence in a Brazilian cohort
Methods
We retrospectively analyzed 519 pKT performed at Hospital Samaritano de Sao Paulo. Among 96 children with glomerulopathies, recurrence was suspected with nephrotic-range proteinuria, protein/creatinine ratio >1, or declining urine output after initially adequate diuresis, after biopsy excluded other causes of graft dysfunction. Treatment included intensive PF and rituximab. Response was assessed at 90 and 365 days. HLA-DR7 frequency was compared by recurrence status
Results
Median age at pKT was 8.5 years; 65.3% were male. FSGS recurrence occurred in 26/96 patients (27.1%). Median time to recurrence was 5 days. Patients received a median of 43 PF sessions (range, 2–160) and 2 rituximab doses (range, 1–5). Median time to first PF was 11 days (IQR 5–55). Overall response was 42.3% at 90 days and 65.4% at one year; 40% of initial non-responders responded by day 365. Graft survival differed by treatment response: survival was >80% in responders and approximately 30% in non-responders after 6 years. HLA-DR7 was more frequent with recurrence than without recurrence (46.2% vs. 24.3%; crude OR, 2.67; 95% CI, 1.04–6.88; Fisher’s exact test, p=0.048)
Conclusion
FSGS recurrence usually occurred early after pKT. Intensive PF plus rituximab was associated with improved response over time, including delayed responses among initial non-responders. Graft survival was mainly determined by treatment response. HLA-DR7 was associated with higher odds of recurrence, supporting its role as a risk marker.