Abstract
Limited data suggest that children with SRNS who were initially steroid sensitive (ISS) have an increased risk of recurrence post transplantation. ISS may be a proxy for those with circulating factor disease. There are no data on risk of transplant loss stratified by ISS. Children who received a kidney transplant between 2000 and 2019 for SRNS in 7 paediatric centres were included. Clinical data were gathered from chart reviews and transplant data were provided from ANZDATA following ethics approval. Transplant survival was estimated using the Kaplan-Meier estimator with Cox modelling used to explore predictors of survival. There were 60 children who were transplanted for SRNS, 31 (51%) male, average age at transplant 11 years (SD 4) and 39 (65%) Caucasian. At presentation, 19/60 (32%) were steroid sensitive before becoming steroid resistant. Of the ISS group, 18/19 (95%) had recurrence post-transplant, compared to 17/41 (41%) of those always steroid resistant (p=0.001). The median time to recurrence was 3 days (inter quartile range 0-12 days), with no difference between the groups (p=0.9). Full remission after recurrence was achieved in 9/18 (50%) of the ISS group and 7/17 (42%) in the always steroid resistant group (p=0.64). Overall, 5-year transplant survival was 57% (95%CI 38-85%) in the ISS group, compared to 78% (95%CI 64-95%) in the always steroid resistant group (p=0.07) (Figure 1). Initial steroid sensitivity is strongly associated with SRNS recurrence. Transplant survival for children with SRNS is poor with a non-significant trend to poorer outcomes for those with initial steroid sensitivity. Further research involving other cohorts is needed to assess if initial steroid sensitivity is associated with poorer graft outcomes.
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