An Important Problem: Posttransplant Focal Segmental Glomerulosclerosis Recurrence and Plasmapheresis

Abstract

OBJECTIVE: Focal segmental glomerulosclerosis (FSGS) as a primary glomerular disease are refractory to therapy and progress to End stage renal disease. (ESRD). After transplantation, the major problems are recurrence of the disease and itstreatment. In thisstudy, We investigated FSGS recurrence.

MATERIAL and METHODS: The graft and patient’s survivals, complications, recurrence rates, and therapeutic approach were documented. Twenty patients with FSGS and 20 patients as controls were included in the study.

RESULTS: The recurrence rate was significantly higher in FSGS group than controls (55 % vs 0 %, p<0.0001). We found that living and cadaveric donor transplantation have similar survival rate in FSGS. One of the most effecting factors on graft survival was genetic similarities between recipient and donor. Pre transplant plasmapheresis was found as effective treatment way for the prevention of FSGS recurrence. While proteinuria recurrence was 38% in the preemptive plasmapheresis group, it was 85% in the other patients with FSGS (p<0.05).

CONCLUSION: The importance of genetic similarities, similar results for graft survival in both living and cadaveric donor transplantation, and plasmapheresis as an effective approach for recurrent disease were the most important findings in this study. It also seems that the most effective therapeutic approach for the prevention of recurrence is pretransplant preemptive plasmapheresis.