Renal transplant outcomes in primary FSGS compared with other recipients and risk factors for recurrence: A national review of the Irish Transplant Registry.

Introduction: Primary focal segmental glomerular sclerosis (p-FSGS) is commonly complicated by recurrence (r-FSGS) post-transplantation. Our objective was to describe Irish outcomes for transplantation after end-stage renal disease (ESRD) due to p-FSGS, specifically rates of, and treatments for, r-FSGS.

Patients And Methods: Irish patients with biopsy-proven FSGS were identified from the Irish National Kidney Transplant database (1982-2015). Medical record review was performed to identify predictors of r-FSGS and treatments for r-FSGS. Transplant outcomes were compared to outcomes in all renal transplants performed during the same time period using registry data. Demographic and clinical predictors of r-FSGS were identified. Statistical analysis was performed using Stata (version 13, College Station, TX, USA).

Results: Thirty-eight transplant recipients had biopsy-proven p-FSGS, 16 received a second transplant. A total of 3846 transplants formed the comparator group. r-FSGS complicated 60.5% (23/38) of first transplants. Eighty-six percent (10/12) of patients with previous r-FSGS developed recurrent disease after further transplantation. Patients with p-FSGS receiving a first renal transplant had higher rate of graft failure than those with another cause of ESRD (HR 1.9, 95% CI 1.152-3.139). Sixteen patients received immunotherapy for r-FSGS; 12 (86%) had at least partial response, but two (14%) developed significant complications.

Discussion: We demonstrate high rates of r-FSGS and describe modest success from with treatments for r-FSGS.