Background: Recurrence of FSGS (focal segmental glomerulosclerosis) after kidney transplant occurs in 30% of adults and up to 80% of children and has impact on allograft survival. Remission rates varies from 30 to 90% and reduced allograft survival is observed. Despite this, there is no established treatment. We aim to evaluate the response to the multitargeted scheme for FSGS recurrence. Methods: Between january 2016 and may 2017, 13 patients were enrolled to received high dose prednisone, PE and cyclosporine for FSGS recurrence. Inclusion criteria were nephrotic range proteinuria without evidence of rejection, glomerulitis or allograft glomerulopathy on biopsy in a kidney transplant recipient (KTR) with FSGS as native kidney disease or undetermined etiology besides suggestive history of nephrotic syndrome. Results: Study population consisted young, mixed, male and non-obese adults with a median time on dialysis of 36 months who were receiving the first or second transplant primarily from deceased donors. 30% of them had biopsy proven FSGS and 70% had undetermined etiology. Median age for chronic kidney disease diagnosis was 39 years (3-60) with an interval of 59 months (0-252) to initiate dialysis. The majority of patients (92%) received thymoglobulin for induction therapy and tacrolimus, prednisone and azathioprine or mycophenolate as maintenance immunosuppression. Seventy percent of patients had early FSGS recurrence (< 6 months), with a median proteinuria of 4g/g, serum creatinine of 4,4 mg/dl and serum albumin of 3,2 g/dL. 50% of patients had confirmed FSGS on allograft biopsy. Median time to start treatment was 5 days (0-34) and all of them received 14 days of IV cyclosporine, 1 mg/kg oral prednisone and PE three times a week. Treatment was discontinued in 9 (69,2%) patients in a median time of 34 days (5-448) due to CMV infection. After discontinuation, 5 (38,4%) patients lost their grafts in a median time of 10 months (3,2-50). Complete and partial remission were observed in 2 (15,4%) and 4 (30,7%) patients. Two patients remain with nephrotic range proteinuria and stable GFR, one of them is in PE due to congestive symptoms. Conclusion: Current strategies used to treat FSGS recurrence are still not efficient with high rates of infection and graft loss and this continues to be a major problem after kidney transplantation.

CITATION INFORMATION: Mansur J., Chang D., Medeiros G., Cristelli M., Viana L., Stopa S., Felipe C., Kirsztajn G., Tedesco-Silva H. Treatment Outcomes of FSGS Recurrence Am J Transplant. 2017;17 (suppl 3).

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