Details

Autor(en) / Beteiligte

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

Titel

Recurrence of FSGS after Kidney Transplantation in Adults

Ist Teil von

• Clinical journal of the American Society of Nephrology, 2020-02, Vol.15 (2), p.247-256

Ort / Verlag

United States: American Society of Nephrology

Erscheinungsjahr

2020

Link zum Volltext

Quelle

Free E-Journal (出版社公開部分のみ）

Beschreibungen/Notizen

• 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. 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. 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/m ; 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. 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.