*Purpose: There was still lack of effective treatment for focal segmental glomerulosclerosis(FSGS)recurrence after renal transplantation. The purpose of this study was to explore the risk factors of FSGS recurrence after transplantation, the effect and long-term prognosis of a high-dose intravenous cyclosporine combined plasma exchange therapy.

*Methods: Retrospectively analyzed 19 kidney transplant patients with primary disease of FSGS in the First Affiliated Hospital of Zhejiang University between January 1, 2008 and October 30, 2018. There were 13 recipients without FSGS recurrence. High-dose intravenous cyclosporine for 2 weeks to maintain the serum cyclosporine levels at about 300-350 ng/ml, and then cyclosporine was changed to oral to maintain the trough concentration at about 250-300 ng/ml combined plasma exchange were used to treat 6 patients with FSGS recurrent after transplantation. Cox regression and t-test analysis were used to find the high risk factors of recurrence, the effect of high-dose cyclosporine combined with plasma exchange and the long-term prognosis of these patients.

*Results: A total of 19 adult patients (mean age 36.7 years old) whose primary disease was FSGS received kidney transplantation, including 6 living-donor kidney transplantation and 13 from DCD donors. The median time of progression to end-stage renal disease(ESRD)was 1.0 year (0.1-5.9 years) and 8.7 years (0.5-14.0 years) in recurrent group and non-recurrent group, respectively (P < 0.05). The sex of recipients, the age of onset, duration of dialysis, the age at operation, HLA mismatching numbers, the immunological induction program, whether prophylactic used of rituximab, donor type, donor age and gender were no different between the two groups. In the recurrence group, 6 patients were treated with high-dose cyclosporine combined plasma exchange, 4 patients were completely remission, 1 patient was partially remission, and 1 patient relapsed about 6 months after partial remission. 19 patients were followed up for a median time of 3.8 years (2.0-10.3 years). Except for 1 patient relapsed again 6 months after partial remission and recovered dialysis, the rest 5 patients had stable renal function and negative proteinuria in the recurrence group who were followed up for 5.6 years (2.0-10.3 years), the mean serum creatinine was 149.7 (99-228) umol / L at the latest reexamination. In addition, 13 patients without recurrence also had stable renal function and no proteinuria until the last reexamination.

*Conclusions: The rapid progression of primary FSGS to ESRD might be an important factor affecting the early recurrence of FSGS after renal transplantation. Early use of high-dose cyclosporine combined with plasma exchange therapy could quickly, effectively and continuously alleviate the recurrent FSGS.

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