Recurrence of FSGS after kidney transplantation in adults

Audrey Uffing, Maria José Pérez-Sáez, Marilda Mazzali, Roberto C. Manfro, Andrea Carla Bauer, Frederico de Sottomaior Drumond, Michelle M. O’shaughnessy, Xingxing S. Cheng, Kuo Kai Chin, Carlucci G. Ventura, Fabiana Agena, Elias David-Neto, Juliana B. Mansur, Gianna Mastroianni Kirsztajn, Helio Tedesco-Silva, Gilberto M.V. Neto, Carlos Arias-Cabrales, Anna Buxeda, Mathilde Bugnazet, Thomas JouvePaolo Malvezzi, Enver Akalin, Omar Alani, Nikhil Agrawal, Gaetano La Manna, Giorgia Comai, Claudia Bini, Saif A. Muhsin, Miguel Carlos Riella, Silvia R. Hokazono, Samira S. Farouk, Meredith Haverly, Suraj Sarvode Mothi, Stefan P. Berger, Paolo Cravedi, Leonardo V. Riella

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Background and objectives FSGS recurrence after kidney transplantation is a major risk factor for graft loss. However, the natural history, clinical predictors, and response to treatment remain unclear because of small sample sizes and poor generalizability of single-center studies, and disease misclassification in registry-based studies. We therefore aimed to determine the incidence, predictors, and treatment response of recurrent FSGS in a large cohort of kidney transplant recipients. Design, setting, participants, & measurements The Post-Transplant Glomerular Disease (TANGO) project is an observational, multicenter, international cohort study that aims to investigate glomerular disease recurrence post-transplantation. Transplant recipients were screened for the diagnosis of idiopathic FSGS between 2005 and 2015 and details were recorded about the transplant, clinical outcomes, treatments, and other risk factors. Results Among 11,742 kidney transplant recipients screened for FSGS, 176 had a diagnosis of idiopathic FSGS and were included. FSGS recurred in 57 patients (32%; 95% confidence interval [95% CI], 25% to 39%) and 39% of them lost their graft over a median of 5 (interquartile range, 3.0–8.1) years. Multivariable Cox regression revealed a higher risk for recurrence with older age at native kidney disease onset (hazard ratio [HR], 1.37 per decade; 95% CI, 1.09 to 1.56). Other predictors were white race (HR, 2.14; 95% CI, 1.08 to 4.22), body mass index at transplant (HR, 0.89 per kg/m2; 95% CI, 0.83 to 0.95), and native kidney nephrectomies (HR, 2.76; 95% CI, 1.16 to 6.57). Plasmapheresis and rituximab were the most frequent treatments (81%). Partial or complete remission occurred in 57% of patients and was associated with better graft survival. Conclusions Idiopathic FSGS recurs post-transplant in one third of cases and is associated with a five-fold higher risk of graft loss. Response to treatment is associated with significantly better outcomes but is achieved in only half of the cases.

Original languageEnglish (US)
Pages (from-to)247-256
Number of pages10
JournalClinical Journal of the American Society of Nephrology
Volume15
Issue number2
DOIs
StatePublished - Feb 7 2020

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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    Uffing, A., Pérez-Sáez, M. J., Mazzali, M., Manfro, R. C., Bauer, A. C., Drumond, F. D. S., O’shaughnessy, M. M., Cheng, X. S., Chin, K. K., Ventura, C. G., Agena, F., David-Neto, E., Mansur, J. B., Kirsztajn, G. M., Tedesco-Silva, H., Neto, G. M. V., Arias-Cabrales, C., Buxeda, A., Bugnazet, M., ... Riella, L. V. (2020). Recurrence of FSGS after kidney transplantation in adults. Clinical Journal of the American Society of Nephrology, 15(2), 247-256. https://doi.org/10.2215/CJN.08970719