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Observational Study
. 2025 Feb 28;40(3):475-483.
doi: 10.1093/ndt/gfae108.

Prophylactic treatment of FSGS recurrence in patients who relapsed on a previous kidney graft

Charlotte Uro-Coste  1 , Céline Lambert  2 , Vincent Audard  3 , Lionel Couzi  4 , Sophie Caillard  5 , Matthias Büchler  6 , Arnaud Del Bello  7 , Paolo Malvezzi  8 , Vincent Pernin  9 , Charlotte Colosio  10 , Laurent Mesnard  11 , Dominique Bertrand  12 , Frank Martinez  13 , Didier Ducloux  14 , Coralie Poulain  15 , Antoine Thierry  16 , Clément Danthu  17 , Clarisse Greze  1 , Camille Lanaret  18 , Valérie Moal  19 , Alexandre Hertig  20 , Jacques Dantal  21 , Christophe Legendre  13 , Valérie Chatelet  22 , Antoine Sicard  23 , Clément Gosset  23 , Nicolas Maillard  24 , Agnès Duveau  25 , Clémence Petit  21 , Nassim Kamar  7 , Anne-Elisabeth Heng  1 , Dany Anglicheau  13 , Cyril Garrouste  1
Affiliations
Observational Study

Prophylactic treatment of FSGS recurrence in patients who relapsed on a previous kidney graft

Charlotte Uro-Coste et al. Nephrol Dial Transplant. .

Abstract

Background: Recurrence of focal segmental glomerulosclerosis (FSGS) is common after kidney transplantation and is classically associated with a significant decrease in graft survival. A major risk factor is a prior history of FSGS recurrence on a previous graft. This analysis reports the impact of a prophylactic treatment of FSGS recurrence in very high-risk patients who experienced a recurrence on a previous graft.

Methods: We performed a retrospective multicentre observational study in 25 French transplantation centres. The inclusion criteria were patients aged more than 18 years who had undergone kidney transplant between 31 December 2004 and 31 December 2020, and who had a history of FSGS recurrence on a previous graft.

Results: We identified 66 patients: 40 received prophylactic treatment (PT+), including intravenous cyclosporine and/or rituximab and/or plasmapheresis, and 26 did not receive any prophylactic treatment (PT-). The time to progression to end-stage kidney disease was similar between groups. The PT+ group was younger at FSGS diagnosis and at the time of kidney retransplantation and lost their previous graft faster. The overall recurrence rate was 72.7% (76.9% in the PT- group and 70.0% in the PT+ group, P = .54). At least partial remission was achieved in 87.5% of patients. The 5-year graft survival was 67.7% [95% confidence interval (CI) 53.4%-78.4%]: 65.1% (95% CI 48.7%-77.4%) in patients with FSGS recurrence vs 77.3% (95% CI 43.8%-92.3%) in patients without recurrence (P = .48).

Conclusion: Our study suggests that prophylactic treatment should not be used routinely in patients receiving a second transplantation after recurrence of FSGS on a previous graft. The recurrence rate is high regardless of the use of prophylactic treatment. However, the 5-year graft survival remains satisfactory.

Keywords: focal segmental glomerulosclerosis; graft survival; kidney transplantation; prophylactic treatment; recurrent glomerular disease.

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Conflict of interest statement

The authors of this manuscript have no conflicts of interest to disclose.

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Flow chart of the study.
Figure 2:
Figure 2:
Cumulative incidence of FSGS recurrence in patients with and without prophylactic treatment. Return to dialysis and death were considered competing events.
Figure 3:
Figure 3:
Graft survival in the study patients with and without FSGS recurrence. Graft survival was define as survival free of dialysis and death.
See this image and copyright information in PMC

References

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