Recurrence of nephrotic syndrome/focal segmental glomerulosclerosis following renal transplantation in children

Richard N Fine, Richard N Fine

Abstract

The incidence of recurrence of nephrotic syndrome/focal segmental glomerulosclerosis (NS/FSGS) is variable (~30%). The incidence of recurrence is less in African-Americans than in whites and Hispanics. Graft survival rates are decreased in recipients with FSGS, especially if remission of the NS is not achieved in those with recurrence. Although controversial, the use of living donor (LD) transplants are not contraindicated; however, obligatory heterozygote parental grafts with a podocin mutation should be used with caution. Optimal treatment to induce a remission post-transplant has not been delineated. Pre-transplant and/or prophylactic post-transplant pre-operative plasmapheresis (PP) for high-risk patients--especially those with recurrence in a previous graft--may be promising. An international multicenter controlled study is required to delineate the optimal approach to prevent and/or treat the recurrence of NS/FSGS.

References

    1. NAPRTCS 2004 Annual Report. Available online at
    1. Hoyer JR, Vernier RL, Najarian JS, Raij L, Simmons RL, Michael AF. Recurrence of idiopathic nephrotic syndrome after renal transplantation. 1972. Lancet. 1972;2(7773):343–348. doi: 10.1016/S0140-6736(72)91734-5.
    1. (1972) Focal glomerulosclerosis. Lancet 2:367
    1. Tejani A, Stablein DH. Recurrence of focal segmental glomerulosclerosis posttransplantation: a special report of the North American Pediatric Renal Transplant Cooperative Study. J Am Soc Nephrol. 1992;2(12 Suppl):S258–S263.
    1. Baum MA, Stablein DM, Panzarino VM, Tejani A, Harmon WE, Alexander SR. Loss of living donor renal allograft survival advantage in children with focal segmental glomerulosclerosis. Kidney Int. 2001;59:328–333. doi: 10.1046/j.1523-1755.2001.00494.x.
    1. Jungraithmayr T, Clara A, Zimmerhackl L. Recurrence of focal segmental glomerulosclerosis (FSGS) after renal transplantation: results of the European Collaborative FSGS transplantation study group (ECOFTS) Pediatr Transplant. 2005;Suppl 6:48.
    1. Gohh RY, Yango AF, Morrissey PE, Monaco AP, Gautam A, Sharma M, McCarthy ET, Savin VJ. Preemptive plasmapheresis and recurrence of FSGS in high-risk renal transplant recipients. Am J Transplant. 2005;5:2907–2912. doi: 10.1111/j.1600-6143.2005.01112.x.
    1. Kerjaschki D. Caught flat-footed: podocyte damage and the molecular bases of focal glomerulosclerosis. J Clin Invest. 2001;108:1583–1587. doi: 10.1172/JCI200114629.
    1. Bertelli R, Ginevri F, Caridi G, Dagnino M, Sandrini S, Di Duca M, Emma F, Sanna-Cherchi S, Scolari F, Neri TM, Murer L, Massella L, Basile G, Rizzoni G, Perfumo F, Ghiggeri GM. Recurrence of focal segmental glomerulosclerosis after renal transplantation in patients with mutations of podocin. Am J Kidney Dis. 2003;41:1314–1321. doi: 10.1016/S0272-6386(03)00364-0.
    1. Caridi G, Perfumo F, Ghiggeri GM. NPHS2 (Podocin) mutations in nephrotic syndrome. Clinical spectrum and fine mechanisms. Pediatr Res. 2005;57:54R–61R. doi: 10.1203/01.PDR.0000160446.01907.B1.
    1. Howie AJ, Pankhurst T, Sarioglu S, Turhan N, Adu D. Evolution of nephrotic-associated focal segmental glomerulosclerosis and relation to the glomerular tip lesion. Kidney Int. 2005;67:987–1001. doi: 10.1111/j.1523-1755.2005.00162.x.
    1. Ingulli E, Tejani A. Racial differences in the incidence and renal outcome of idiopathic focal segmental glomerulosclerosis in children. Pediatr Nephrol. 1991;5:393–397. doi: 10.1007/BF01453661.
    1. Baqi N, Tejani A. Recurrence of the original disease in pediatric renal transplantation. J Nephrol. 1997;10:85–92.
    1. Bartosh SM, Stablein DM, Fine RN (2004) Recurrence of focal segmental glomerulosclerosis (FSGS) following pediatric kidney transplantation in the modern immunosuppression era: a report from the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Submitted for presentation at the American Transplant Congress, Boston, Massachusetts, 15–19 May 2004
    1. Savin VJ, Sharma R, Sharma M, McCarthy ET, Swan SK, Ellis E, Lovell H, Warady B, Gunwar S, Chonko AM, Artero M, Vincenti F. Circulating factor associated with increased glomerular permeability to albumin in recurrent focal segmental glomerulosclerosis. N Engl J Med. 1996;334:878–883. doi: 10.1056/NEJM199604043341402.
    1. Raafat R, Travis LB, Kalia A, Diven S. Role of transplant induction therapy on recurrence rate of focal segmental glomerulosclerosis. Pediatr Nephrol. 2000;14:189–194. doi: 10.1007/s004670050038.
    1. Gagnadoux MF. Ask the expert. Does antibody induction therapy with daclizumab or basiliximab increase the risk of recurrence of post-transplant focal segmental glomerulosclerosis? Pediatr Nephrol. 2002;17:305. doi: 10.1007/s00467-002-0828-z.
    1. Sheth RD, Kale AS, Goldstein SL, Brewer ED. Rapid recurrence of post-transplant FSGS in pediatric patients after daclizumab induction. Pediatr Nephrol. 2001;16:C190. doi: 10.1007/s004670000521.
    1. Hubsch H, Montane B, Abitbol C, Chandar J, Shariatmadar S, Ciancio G, Burke G, Miller J, Strauss J, Zilleruelo G. Recurrent focal glomerulosclerosis in pediatric renal allografts: the Miami experience. Pediatr Nephrol. 2005;20:210–216. doi: 10.1007/s00467-004-1706-7.
    1. Odorico JS, Knechtle SJ, Rayhill SC, Pirsch JD, D’Alessandro AM, Belzer FO, Sollinger HW. The influence of native nephrectomy on the incidence of recurrent disease following renal transplantation for primary glomerulonephritis. Transplantation. 1996;61:228–234. doi: 10.1097/00007890-199601270-00012.
    1. Baum MA, Ho M, Stablein D, Alexander SR, North American Pediatric Renal Transplant Cooperative Study Outcome of renal transplantation in adolescents with focal segmental glomerulosclerosis. Pediatr Transplant. 2002;6:488–492. doi: 10.1034/j.1399-3046.2002.02036.x.
    1. Huang K, Ferris ME, Andreoni KA, Gipson DS. The differential effect of race among pediatric kidney transplant recipients with focal segmental glomerulosclerosis. Am J Kidney Dis. 2004;43:1082–1090. doi: 10.1053/j.ajkd.2004.03.017.
    1. Schachter AD, Harmon WE. Single-center analysis of early recurrence of nephrotic syndrome following renal transplantation in children. Pediatr Transplant. 2001;5:406–409. doi: 10.1034/j.1399-3046.2001.t01-2-00024.x.
    1. Sweet SC, Wong HH, Webber SA, Horslen S, Guidinger MK, Fine RN, Magee JC. Pediatric transplantation in the United States, 1995–2004. Am J Transplant. 2006;6:1132–1152. doi: 10.1111/j.1600-6143.2006.01271.x.
    1. Cameron JS, Senguttuvan P, Hartley B, Rigden SP, Chantler C, Koffman G, Williams DG, Ogg CS. Focal segmental glomerulosclerosis in fifty-nine renal allografts from a single centre; analysis of risk factors for recurrence. Transplant Proc. 1989;21:2117–2118.
    1. Senggutuvan P, Cameron JS, Hartley RB, Rigden S, Chantler C, Haycock G, Williams DG, Ogg C, Koffman G. Recurrence of focal segmental glomerulosclerosis in transplanted kidneys: analysis of incidence and risk factors in 59 allografts. Pediatr Nephrol. 1990;4:21–28. doi: 10.1007/BF00858431.
    1. First MR. Living-related donor transplants should be performed with caution in patients with focal segmental glomerulosclerosis. Pediatr Nephrol. 1995;9(Suppl):S40–S42. doi: 10.1007/BF00867682.
    1. Winn MP, Alkhunaizi AM, Bennett WM, Garber RL, Howell DN, Butterly DW, Conlon PJ. Focal segmental glomerulosclerosis: a need for caution in live-related renal transplantation. Am J Kidney Dis. 1999;33:970–974. doi: 10.1016/S0272-6386(99)70435-X.
    1. Ruf RG, Lichtenberger A, Karle SM, Haas JP, Anacleto FE, Schultheiss M, Zalewski I, Imm A, Ruf EM, Mucha B, Bagga A, Neuhaus T, Fuchshuber A, Bakkaloglu A, Hildebrandt F, Arbeitsgemeinschaft Fur Padiatrische Nephrologie Study Group Patients with mutations in NPHS2 (podocin) do not respond to standard steroid treatment of nephrotic syndrome. J Am Soc Nephrol. 2004;15:722–732. doi: 10.1097/01.ASN.0000113552.59155.72.
    1. Weber S, Gribouval O, Esquivel EL, Moriniere V, Tete MJ, Legendre C, Niaudet P, Antignac C. NPHS2 mutation analysis shows genetic heterogeneity of steroid-resistant nephrotic syndrome and low post-transplant recurrence. Kidney Int. 2004;66:571–579. doi: 10.1111/j.1523-1755.2004.00776.x.
    1. Ismail-Allouch M, Burke G, Nery J, Roth D, Esquenazi V, Ruiz P, Miller J. Rapidly progressive focal segmental glomerulosclerosis occurring in a living related kidney transplant donor: case report and review of 21 cases of kidney transplants for primary FSGS. Transplant Proc. 1993;25:2176–2177.
    1. Laufer J, Ettenger RB, Ho WG, Cohen AH, Marik JL, Fine RN. Plasma exchange for recurrent nephrotic syndrome following renal transplantation. Transplantation. 1988;46(4):540–542. doi: 10.1097/00007890-198810000-00014.
    1. Ingulli E, Tejani A, Butt KM, Rajpoot D, Gonzalez R, Pomrantz A, Ettenger R. High-dose cyclosporine therapy in recurrent nephrotic syndrome following renal transplantation. Transplantation. 1990;49:219–221. doi: 10.1097/00007890-199001000-00050.
    1. Raafat RH, Kalia A, Travis LB, Diven SC. High-dose oral cyclosporine therapy for recurrent focal segmental glomerulosclerosis in children. Am J Kidney Dis. 2004;44:50–56. doi: 10.1053/j.ajkd.2004.03.028.
    1. Cochat P, Kassir A, Colon S, Glastre C, Tourniaire B, Parchoux B, Martin X, David L. Recurrent nephrotic syndrome after transplantation: early treatment with plasmaphaeresis and cyclophosphamide. Pediatr Nephrol. 1993;7:50–54. doi: 10.1007/BF00861567.
    1. Dantal J, Bigot E, Bogers W, Testa A, Kriaa F, Jacques Y, Hurault de Ligny B, Niaudet P, Charpentier B, Soulillou JP. Effect of plasma protein adsorption on protein excretion in kidney-transplant recipients with recurrent nephrotic syndrome. N Engl J Med. 1994;330:7–14. doi: 10.1056/NEJM199401063300102.
    1. Salomon R, Gagnadoux MF, Niaudet P. Intravenous cyclosporine therapy in recurrent nephrotic syndrome after renal transplantation in children. Transplantation. 2003;27:810–814. doi: 10.1097/01.TP.0000055215.20367.21.
    1. Ohta T, Kawaguchi H, Hattori M, Komatsu Y, Akioka Y, Nagata M, Shiraga H, Ito K, Takahashi K, Ishikawa N, Tanabe K, Yamaguchi Y, Ota K. Effect of pre-and postoperative plasmapheresis on posttransplant recurrence of focal segmental glomerulosclerosis in children. Transplantation. 2001;71:628–633. doi: 10.1097/00007890-200103150-00008.
    1. Rianthavorn P, Bhakta N, Gjertson D, Ettenger R. A coherent approach to recurrent focal segmental glomerulosclerosis in children? The effects of high dose cyclosporine and pretransplant plasmapheresis. Pediatr Transplant. 2005;Suppl 6:48.
    1. Kawamura T, Motoyama O, Aikawa A, Ohara T, Motoyama O, Hasegawa A. Outcome of first living related renal transplantation for pediatric patients with focal segmental glomerulonephritis in Japan—a single center experience. Pediatr Transplant. 2005;Suppl 6:59–60.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere