Renal allograft survival in transplant recipients with focal segmental glomerulosclerosis

Toshihiro Shimizu,Taro Kubo,Yoshitaka Kinoshita,Takahiro Shinzato,Takashi Yamada ,Koji Nanmoku

doi:10.34172/jnp.2020.15

Abstract

Introduction: The frequency that idiopathic focal segmental glomerulosclerosis (FSGS) recurs in renal allografts is reportedly 20-50%, but the epidemiology of secondary FSGS in this setting has scarcely been addressed. Objectives: The aim of this study was to examine the incidence, etiology, and subtypes of FSGS in renal allograft recipients and allograft survival in recipients with FSGS. Patients and Methods: As a retrospective review, we examined medical records of 359 consecutive renal allograft recipients (living donors, 329; cadaveric donors, 30). In 121 of these patients, allograft dysfunction or proteinuria prompted biopsies. We compared allograft survival in recipients with and without FSGS. We then determined histologic subtypes of FSGS using the Columbia classification and categorized FSGS as recurrent or de novo, and idiopathic or secondary. Results: Of 121 subjects who were biopsied, six with inadequate specimens (<10 glomeruli) were excluded. Only 17 of those remaining (n=115) were diagnosed as secondary FSGS. Renal allograft survival did not differ significantly in patients with or without FSGS (P=0.953). Subtypes of FSGS were as follows; not otherwise specified (NOS; n=8), collapsing (n=5), cellular (n=2), and perihilar (n=2). Conclusion: Secondary FSGS was observed in 14.5% of biopsies of renal allograft recipients and seemed no significant impact on allograft survival.

Highlights

The frequency that idiopathic focal segmental glomerulosclerosis (FSGS) recurs in renal allografts is reportedly 20-50%, but the epidemiology of secondary Focal segmental glomerulosclerosis (FSGS) in this setting has scarcely been addressed
Secondary FSGS is rooted in a multiplicity of disorders, such as hyperfiltration [8], reduced renal mass [9], reflux nephropathy [10], obesity [11,12,13,14,15,16], drugs [17,18,19,20,21,22,23,24], viruses [25,26,27,28], or glomerular disease [immunoglobulin A nephropathy (IgAN) [29] and lupus nephritis [30,31,32] in particular]
Renal allografts may be affected, in conjunction with rejection [33,34], the epidemiology of secondary FSGS has scarcely been addressed in this regard

Summary

Introduction

The frequency that idiopathic focal segmental glomerulosclerosis (FSGS) recurs in renal allografts is reportedly 20-50%, but the epidemiology of secondary FSGS in this setting has scarcely been addressed. Conclusion: Secondary FSGS was observed in 14.5% of biopsies of renal allograft recipients and seemed no significant impact on allograft survival. Focal segmental glomerulosclerosis (FSGS) may develop in renal allografts for various reasons. It may recur or arise de novo and may be idiopathic or secondary. The incidence of recurring idiopathic FSGS in renal allografts is reportedly 20%-50% [1,2,3,4,5,6], with a 2.6% incidence of related allograft loss over 2.96 years (mean interval; 8.2% lost to follow-up) [4] or 12.7% loss in 10 years (95% confidence interval; 7.3-21.6) [7]. Renal allografts may be affected, in conjunction with rejection [33,34], the epidemiology of secondary FSGS has scarcely been addressed in this regard

Objectives

Methods

Results