Primary focal segmental glomerular sclerosis (p-FSGS) raises specific peri-transplant concerns, one of which is disease recurrence (r-FSGS). We aimed to compare transplant outcomes in patients with p-FSGS with all other transplants performed in Ireland from 1982-2015 and identify risk factors for r-FSGS in an Irish transplant cohort.

All renal transplant recipients with a clinical diagnosis code of 'FSGS' in the Irish National Kidney Transplant database were identified. Histology reports were reviewed to ensure all included patients had biopsy-proven p-FSGS. An extensive clinical dataset was compiled through chart and electronic data review, with specific focus on r-FSGS. Outcomes in this cohort were compared to outcomes in all renal transplants performed during the same time period. Demographic and clinical predictors of r-FSGS were identified. Statistical analysis was performed using Stata statistical software (version 13, College Station, Texas).

Thirty-four transplant recipients had biopsy-proven p-FSGS, sixteen of whom received a second transplant, giving fifty episodes of transplantation for analysis. 3847 transplants formed the comparator group. r-FSGS complicated 58% of first transplants in those with p-FSGS and 77% of second transplants in those with previous r-FSGS. Graft survival was reduced in patients with p-FSGS (p<0.001 after adjustment for age at transplant) with median graft survival of 8 years. Rapid progression to end-stage renal disease (ESRD) (p=0.021) and high-grade proteinuria pre-transplant (p=0.040) were significantly associated with r-FSGS. Fourteen patients received immunotherapy for r-FSGS; 12 (86%) had at least partial response but two (14%) developed significant treatment-related complications.

Inferior transplant outcomes in p-FSGS highlight the importance of careful pre-transplant counselling of patients and living donors, and meticulous post-transplant surveillance for r-FSGS. Particular attention should be paid to time from diagnosis to ESRD and degree of proteinuria pre-transplant when considering the risk of r-FSGS.

CITATION INFORMATION: Cormican S, Kennedy C, O'Kelly P, Doyle B, Dorman A, Conlon P. Renal Transplant Outcomes in Primary FSGS Compared with Other Recipients: A National Review of the Irish Transplant Registry. Am J Transplant. 2017;17 (suppl 3).

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