J Korean Soc Transplant.  2006 Dec;20(2):201-206.

Kidney Transplantation in Patients with Focal Segmental Glomerulosclerosis

• Lee HJ
• Kim HT
• Cho WH
• Sung JH
• Jin KB
• Hwang EA
• Han SY
• Park SB
• Kim HC
• Ju SH
• Koo JH

Abstract

Purpose: Kidney transplantation (KT) is one of the important treatment modality for the patients with focal segmental glomerulosclerosis (FSGS), but high recurrence rate and resulting graft failure is still a great obstacle. In order to compare the results of transplantation for recipient with FSGS, we reviewed our cases retrospectively.
Methods
Thirty-six biopsy proven FSGS were reviewed and compared their clinical characteristics according to their recurrence status, retrospectively. Patient with significant proteinuria after KT was re-biopsied and light- and electron-microscopic study were done to confirm the recurrence of original disease.
Results
Recurrence of FSGS was confirmed histologically in 13 (36%) recipients. Among 15 failed grafts, 9 grafts lost their function by recurrence of FSGS. Higher rate of acute rejection associated in recurred group (53% vs 39%). Five-year graft survival of recurred group was significantly lower than non-recurred group (65% vs 78%, P=0.0071). Cyclosporin group showed more frequent recurrence of FSGS after transplantation than tacrolimus group but no statistical significance (P>0.05). Plasmapheresis (PP) was done in 8 patients with early recurred FSGS and was effective in reducing the grade of proteinuria. Their long-term graft survival, however, was poor even though half of the recurred patients maintain their graft function until 5 years after PP.
Conclusion
Our data showed that the recurred FSGS group showed higher rate of graft loss and poor graft survival. Since the FSGS recurrence is directly related with graft survival, large data analysis will be necessary to analyze the risk factor of recurrence and prevent adverse effect of recurrence of FSGS after KT.

Keyword

Focal segmental glomerulosclerosis; Kidney transplantation; Plasmapheresis

MeSH Terms

Biopsy
Cyclosporine
Glomerulosclerosis, Focal Segmental*
Graft Survival
Humans
Kidney Transplantation*
Kidney*
Plasmapheresis
Proteinuria
Recurrence
Retrospective Studies
Risk Factors
Statistics as Topic
Tacrolimus
Transplants
Cyclosporine
Tacrolimus