Long-term outcome of kidney transplantation in recipients with focal segmental glomerulosclerosis

Francis, Anna, Trnka, Peter and McTaggart, Steven J. (2016) Long-term outcome of kidney transplantation in recipients with focal segmental glomerulosclerosis. Clinical Journal of the American Society of Nephrology, 11 11: 2041-2046. doi:10.2215/CJN.03060316


Author Francis, Anna
Trnka, Peter
McTaggart, Steven J.
Title Long-term outcome of kidney transplantation in recipients with focal segmental glomerulosclerosis
Journal name Clinical Journal of the American Society of Nephrology   Check publisher's open access policy
ISSN 1555-9041
1555-905X
Publication date 2016-11-07
Sub-type Article (original research)
DOI 10.2215/CJN.03060316
Open Access Status Not yet assessed
Volume 11
Issue 11
Start page 2041
End page 2046
Total pages 6
Place of publication Washington, DC, United States
Publisher American Society of Nephrology
Language eng
Abstract FSGS can recur after kidney transplantation and is associated with poor graft outcomes. We aimed to assess the incidence of FSGS recurrence post-transplant and determine the effect of graft source on recurrence and graft survival in patients with biopsy-proven FSGS.

Using the Australian and New Zealand Dialysis and Transplant Registry, we assessed incidence of FSGS, the influence of donor type on the risk of FSGS recurrence, and graft loss in recipients with ESRD caused by primary FSGS using Kaplan-Meier and logistic regression analyses.

Between 1992 and 2011, 736 first kidney transplants were performed in 666 adults and 70 children (≤20 years old) with biopsy-proven primary FSGS. FSGS recurred in 76 (10.3%) patients. Younger age (P<0.001), nonwhite ethnicity (P=0.02), and having a live donor (P=0.02) were independent risk factors associated with recurrence. Median graft survival was significantly better for live donor compared with deceased donor grafts (14.8 versus 12.1 years; P<0.01). Disease recurrence predicted poor graft outcomes, with 52% (95% confidence interval, 40% to 63%) 5-year graft survival in the recurrence group compared with 83% (95% confidence interval, 79% to 86%) in the group without recurrent disease (P<0.001).

FSGS recurrence after kidney transplantation was more common in live donor kidneys. Despite this, graft survival in live donor recipients was significantly better for both children and adults with FSGS. We propose that live donor transplantation should not be avoided in patients with FSGS.
Formatted abstract
Background and objectives: FSGS can recur after kidney transplantation and is associated with poor graft outcomes. We aimed to assess the incidence of FSGS recurrence post-transplant and determine the effect of graft source on recurrence and graft survival in patients with biopsy-proven FSGS.

Design, setting, participants, & measurements: Using the Australian and New Zealand Dialysis and Transplant Registry, we assessed incidence of FSGS, the influence of donor type on the risk of FSGS recurrence, and graft loss in recipients with ESRD caused by primary FSGS using Kaplan–Meier and logistic regression analyses.

Results: Between 1992 and 2011, 736 first kidney transplants were performed in 666 adults and 70 children (≤20 years old) with biopsy–proven primary FSGS. FSGS recurred in 76 (10.3%) patients. Younger age (P<0.001), nonwhite ethnicity (P=0.02), and having a live donor (P=0.02) were independent risk factors associated with recurrence. Median graft survival was significantly better for live donor compared with deceased donor grafts (14.8 versus 12.1 years; P<0.01). Disease recurrence predicted poor graft outcomes, with 52% (95% confidence interval, 40% to 63%) 5-year graft survival in the recurrence group compared with 83% (95% confidence interval, 79% to 86%) in the group without recurrent disease (P<0.001).

Conclusions: FSGS recurrence after kidney transplantation was more common in live donor kidneys. Despite this, graft survival in live donor recipients was significantly better for both children and adults with FSGS. We propose that live donor transplantation should not be avoided in patients with FSGS.
Keyword Focal segmental glomerulosclerosis
Living donor
Deceased donor
Graft survival
Kidney
Kidney transplantation
Renal dialysis risk factors
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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