Purpose: To describe clinical-laboratorial profile and outcome of patients diagnosed with recurrent FSGS submitted to plasmapheresis.

Methods: Retrospective single-center cohort study including all patients with recurrent FSGS submitted to plasmapheresis between 2003 and 2014.

Results: From 9017 kidney transplants, 70 patients (median: 29 years, min 5 – max 62, 58% male) were submitted to plasmapheresis due to recurrent FSGS. In 51% of cases, histological diagnosis of FSGS as a cause of chronic kidney disease was confirmed. Seventy percent of patients received a kidney from a deceased donor; mean cold ischemia time was 23 hours. The most frequently immunosuppressive regimen consisted of tacrolimus, prednisone, azathioprine or mycophenolate (75%). The incidence of delayed graft function was of 70% in recipients of deceased and 19% in recipients of living donor kidney transplants. Proteinuria to creatinine ratio > 0.5 g/g was detected within 15 days after kidney transplantation and nephrotic range proteinuria at a mean time of 64 days. The first biopsy was performed at a mean time of 24 days but in only 17% of the cases FSGS histological lesions were observed. Mean time to histological diagnosis was 124 days. Mean time to first plasmapheresis was 77 days. A significant portion of the patients received methylprednisolone pulse therapy (80%) and rituximab treatment (34%). Forty eight percent presented partial remission after an average of 83 plasmapheresis sessions, and complete remission occurred in 22% of cases. Infection occurred in 69% of the patients. One, three and five-years allograft survivals were 70.8%, 41.4% and 32.7%, respectively.

Conclusion: FSGS r recurs early after kidney transplantation, with clinical manifestations preceding the development of histological lesions. Treatment was associated with high incidence of infection, low complete remission rates and higher rates of graft loss, reinforcing the need for further studies to determine a more efficient treatment.

CITATION INFORMATION: Mansur J, Basso G, Cristelli M, Mata G, Sandes-Freitas T, Kirsztajn G, Tedesco-Silva H, Medina-Pestana J. Analysis of FSGS (Focal Segmental Glomerulosclerosis) Recurrence After Renal Transplantation. Am J Transplant. 2016;16 (suppl 3).

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