Recurrence of FSGS after Kidney Transplantation in Adults.

Adult Brazil Europe Female Glomerulosclerosis, Focal Segmental / diagnosis Graft Survival / drug effects Humans Immunosuppressive Agents / therapeutic use Kidney Transplantation / adverse effects Male Middle Aged Plasmapheresis Recurrence Retreatment Retrospective Studies Risk Assessment Risk Factors Rituximab / therapeutic use Time Factors Treatment Outcome United States

Nephrectomy adult body mass index cohort studies focal segmental glomerulosclerosis graft survival humans incidence kidney kidney diseases kidney transplantation plasmapheresis recurrence registries renal transplantation risk factors rituximab sample size transplant outcomes transplant recipients treatment outcome

Journal

Clinical journal of the American Society of Nephrology : CJASN

ISSN: 1555-905X

Titre abrégé: Clin J Am Soc Nephrol

Pays: United States

ID NLM: 101271570

Informations de publication

Date de publication:
07 02 2020

Historique:

received: 31 07 2019

accepted: 29 11 2019

pubmed: 25 1 2020

medline: 1 6 2021

entrez: 25 1 2020

Statut: ppublish

Résumé

FSGS recurrence after kidney transplantation is a major risk factor for graft loss. However, the natural history, clinical predictors, and response to treatment remain unclear because of small sample sizes and poor generalizability of single-center studies, and disease misclassification in registry-based studies. We therefore aimed to determine the incidence, predictors, and treatment response of recurrent FSGS in a large cohort of kidney transplant recipients. The Post-Transplant Glomerular Disease (TANGO) project is an observational, multicenter, international cohort study that aims to investigate glomerular disease recurrence post-transplantation. Transplant recipients were screened for the diagnosis of idiopathic FSGS between 2005 and 2015 and details were recorded about the transplant, clinical outcomes, treatments, and other risk factors. Among 11,742 kidney transplant recipients screened for FSGS, 176 had a diagnosis of idiopathic FSGS and were included. FSGS recurred in 57 patients (32%; 95% confidence interval [95% CI], 25% to 39%) and 39% of them lost their graft over a median of 5 (interquartile range, 3.0-8.1) years. Multivariable Cox regression revealed a higher risk for recurrence with older age at native kidney disease onset (hazard ratio [HR], 1.37 per decade; 95% CI, 1.09 to 1.56). Other predictors were white race (HR, 2.14; 95% CI, 1.08 to 4.22), body mass index at transplant (HR, 0.89 per kg/m Idiopathic FSGS recurs post-transplant in one third of cases and is associated with a five-fold higher risk of graft loss. Response to treatment is associated with significantly better outcomes but is achieved in only half of the cases.

Sections du résumé

BACKGROUND AND OBJECTIVES

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

The Post-Transplant Glomerular Disease (TANGO) project is an observational, multicenter, international cohort study that aims to investigate glomerular disease recurrence post-transplantation. Transplant recipients were screened for the diagnosis of idiopathic FSGS between 2005 and 2015 and details were recorded about the transplant, clinical outcomes, treatments, and other risk factors.

RESULTS

Among 11,742 kidney transplant recipients screened for FSGS, 176 had a diagnosis of idiopathic FSGS and were included. FSGS recurred in 57 patients (32%; 95% confidence interval [95% CI], 25% to 39%) and 39% of them lost their graft over a median of 5 (interquartile range, 3.0-8.1) years. Multivariable Cox regression revealed a higher risk for recurrence with older age at native kidney disease onset (hazard ratio [HR], 1.37 per decade; 95% CI, 1.09 to 1.56). Other predictors were white race (HR, 2.14; 95% CI, 1.08 to 4.22), body mass index at transplant (HR, 0.89 per kg/m

CONCLUSIONS

Idiopathic FSGS recurs post-transplant in one third of cases and is associated with a five-fold higher risk of graft loss. Response to treatment is associated with significantly better outcomes but is achieved in only half of the cases.

Identifiants

DOI: 10.2215/CJN.08970719 PMID: 31974287 PMC: PMC7015092

pubmed: 31974287

pii: 01277230-202002000-00014

doi: 10.2215/CJN.08970719

pmc: PMC7015092

doi:

Substances chimiques

Immunosuppressive Agents 0

Rituximab 4F4X42SYQ6

Types de publication

Journal Article Multicenter Study Observational Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

247-256

Subventions

Organisme : NIDDK NIH HHS

ID : R01 DK119431

Pays : United States

Organisme : NCATS NIH HHS

ID : UL1 TR001102

Pays : United States

Commentaires et corrections

Type : CommentIn

Informations de copyright

Références

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