Risk factors and outcome of focal and segmental glomerulosclerosis recurrence in adult renal transplant recipients

Nephrol Dial Transplant. 2006 Apr;21(4):1053-9. doi: 10.1093/ndt/gfk005. Epub 2005 Dec 19.


Background: Recurrence of nephrotic syndrome (NS) after renal transplantation for primary focal segmental glomerulosclerosis (FSGS) is a frequent and still unpredictable complication. However, risk factors for recurrence have not yet been clearly identified.

Methods: Data from 33 patients who underwent 35 renal transplantations for FSGS in two French centres are reported.

Results: Recurrent NS occurred in 12 transplant recipients (34%). A significantly higher number of patients in the group with recurrence (R group) compared with the group without recurrence (NR group) received cyclosporine for FSGS treatment before transplantation (83.3% vs 43.4%, P<0.02). Donors of R group recipients were significantly older than those of the non-NR group recipients (42.8 years vs 35 years, P<0.05). A higher number of patients from the R group required post-transplantation dialysis (33.3% vs 17.4%, P = 0.002). Surprisingly, acute rejection occurred more frequently in patients of the NR group compared with the R group, although the difference was not significant. Among the 12 patients with NS relapse, 9 were treated with plasmapheresis. Graft loss related to recurrence occurred in 6 cases. The 5-year graft survival was significantly lower in patients with recurrent NS compared with patients without recurrence (57% vs 82%, P<0.001).

Conclusion: This study confirms the benefit to identify in the future clinical or biological predictive risk factors for NS recurrence after renal transplantation. It also indicates that donor age is a reliable risk factor for recurrence in adult recipients and suggests for the first time a possible opposite relationship between recurrent FSGS and acute rejection.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adult
  • Female
  • Glomerular Filtration Rate
  • Glomerulosclerosis, Focal Segmental / etiology*
  • Glomerulosclerosis, Focal Segmental / surgery*
  • Graft Survival
  • Humans
  • Kidney Transplantation*
  • Male
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome