Background: suPAR was shown to be elevated in approximately 60% of patients (pts) with primary FSGS. Increased levels before transplantation were predictive of FSGS recurrence, which occurs in up to 30% of transplanted kidneys. Previous studies have found that suPAR is a factor that may be linked to FSGS pathology. The purpose of this study is to investigate serum levels of suPAR in pts with FSGS during the course of kidney transplantation and to evaluate suPAR as an early predictor of FSGS recurrence after transplantation.

Methods: In this ongoing prospective single-center study so far nine pts with histologically proven FSGS were included (living donation (n=7), deceased donation (n=2), mean age: 35±11; 56% female pts; therapy after transplantation consisted of basiliximab, MMF, CNI and steroids; lowest creatinine after transplantation 1,26±0,31 mg/dL, mean proteinuria 524±591 mg/24h). The serum samples for suPAR measurement by ELISA were obtained before transplantation and in week 1, 4, 12, 24 after transplantation.

Results: Mean suPAR levels before the transplantation were 4424±2568 pg/ml. In 8 from 9 pts they were above the cut-off level of 3000 pg/ml, determined as predictive for pts with primary FSGS. suPAR levels decreased significantly (32%) after the transplantation (2676±566 pg/ml on week 4; p<0.008 vs. pre-transplant values, Fig.1). So far recurrence was observed in 2 from 9 patients.

Conclusions: In FSGS pts the elevated suPAR level decreased by 32% after transplantation and stabilized at this significantly lower level, possibly due to the effect of the immunosuppression. Further observation is necessary to evaluate suPAR as a possible predictor for FSGS recurrence after transplantation and – if proven right – to establish reliable cut-off values.

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