TY - JOUR
T1 - Recurrence of FSGS after kidney transplantation in adults
AU - Uffing, Audrey
AU - Pérez-Sáez, Maria José
AU - Mazzali, Marilda
AU - Manfro, Roberto C.
AU - Bauer, Andrea Carla
AU - Drumond, Frederico de Sottomaior
AU - O’shaughnessy, Michelle M.
AU - Cheng, Xingxing S.
AU - Chin, Kuo Kai
AU - Ventura, Carlucci G.
AU - Agena, Fabiana
AU - David-Neto, Elias
AU - Mansur, Juliana B.
AU - Kirsztajn, Gianna Mastroianni
AU - Tedesco-Silva, Helio
AU - Neto, Gilberto M.V.
AU - Arias-Cabrales, Carlos
AU - Buxeda, Anna
AU - Bugnazet, Mathilde
AU - Jouve, Thomas
AU - Malvezzi, Paolo
AU - Akalin, Enver
AU - Alani, Omar
AU - Agrawal, Nikhil
AU - La Manna, Gaetano
AU - Comai, Giorgia
AU - Bini, Claudia
AU - Muhsin, Saif A.
AU - Riella, Miguel Carlos
AU - Hokazono, Silvia R.
AU - Farouk, Samira S.
AU - Haverly, Meredith
AU - Mothi, Suraj Sarvode
AU - Berger, Stefan P.
AU - Cravedi, Paolo
AU - Riella, Leonardo V.
N1 - Publisher Copyright:
© 2020 by the American Society of Nephrology.
PY - 2020/2/7
Y1 - 2020/2/7
N2 - 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.
AB - 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.
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U2 - 10.2215/CJN.08970719
DO - 10.2215/CJN.08970719
M3 - Article
C2 - 31974287
AN - SCOPUS:85079096720
SN - 1555-9041
VL - 15
SP - 247
EP - 256
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 2
ER -