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NDT Advance Access published online on December 19, 2005
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfk005
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received June 23, 2005
Accepted November 28, 2005

Original Article

Risk factors and outcome of focal and segmental glomerulosclerosis recurrence in adult renal transplant recipients

Agathe Pardon 1, Vincent Audard 2, Sophie Caillard 3, Bruno Moulin 4, Dominique Desvaux 1, Bouteina Bentaarit 1, Philippe Remy 1, Dil Sahali 1, Françoise Roudot-Thoraval 5, Philippe Lang 1, and Philippe Grimbert 1 *

1 Department of Nephrology and Transplantation, Hôpital Henri Mondor, AP-HP and Faivlte de Midecine, Paris XII, Créteil, France
2 Department of Nephrology and Transplantation, Hôpital Henri Mondor, AP-HP and Faivlte de Midecine, Paris XII, Créteil, France; VA and SC have equally contributed to this work
3 Department of Nephrology-Transplantation, Hôpitaux Universitaires de Strasbourg, France; VA and SC have equally contributed to this work
4 Department of Nephrology-Transplantation, Hôpitaux Universitaires de Strasbourg, France
5 Department of Public Health and Biostatistics, Hôpital Henri Mondor, AP-HP and Faivlte de Midecine, Paris XII, Créteil, France

* To whom correspondence should be addressed.
Philippe Grimbert, E-mail: philippe.grimbert{at}hmn.ap-hop-paris.fr



  Abstract

Background. Recurrence of nephrotic syndrome (NS) after renal transplantation for primary focal segmental glomerulosclerosis (FSGS) is a frequent and still unpredictable complication. However, risk factors for recurrence have not yet been clearly identified.

Methods. Data from 33 patients who underwent 35 renal transplantations for FSGS in two French centres are reported.

Results. Recurrent NS occurred in 12 transplant recipients (34%). A significantly higher number of patients in the group with recurrence (R group) compared with the group without recurrence (NR group) received cyclosporine for FSGS treatment before transplantation (83.3% vs 43.4%, P<0.02). Donors of R group recipients were significantly older than those of the non-NR group recipients (42.8 years vs 35 years, P<0.05). A higher number of patients from the R group required post-transplantation dialysis (33.3% vs 17.4%, P = 0.002). Surprisingly, acute rejection occurred more frequently in patients of the NR group compared with the R group, although the difference was not significant. Among the 12 patients with NS relapse, 9 were treated with plasmapheresis. Graft loss related to recurrence occurred in 6 cases. The 5-year graft survival was significantly lower in patients with recurrent NS compared with patients without recurrence (57% vs 82%, P<0.001).

Conclusion. This study confirms the benefit to identify in the future clinical or biological predictive risk factors for NS recurrence after renal transplantation. It also indicates that donor age is a reliable risk factor for recurrence in adult recipients and suggests for the first time a possible opposite relationship between recurrent FSGS and acute rejection.

Keywords: acute rejection; focal segmental glomerulosclerosis; recurrence; renal transplantation.
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