Recurrent focal glomerulosclerosis in pediatric renal allografts

The Miami experience

Hans Hubsch, Brenda Montané, Carolyn Abitbol, Jayanthi Chandar, Sherry Shariatmadar, Gaetano Ciancio, George W Burke, Joshua Miller, José Strauss, Gaston E Zilleruelo

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Recurrence of focal glomerulosclerosis (FSGS) following renal transplantation is a common cause of allograft loss and clinical morbidity. Recent attempts to control proteinuria and morbidity with plasmapheresis (PP) have met with limited success. Our experience with the use of mycophenolate mofetil (MMF) and angiotensin blockade (AB) in the management of refractory FSGS pre transplant suggested its potential benefit in post-transplant recurrence. This report presents our 25-year experience in pediatric renal transplantation of patients with FSGS divided into two treatment eras: Era 1-prior to use of daclizumab (anti-IL-2R) and Era 2-after daclizumab. A total of 179 pediatric patients were transplanted during the 25-year period. FSGS was confirmed in 27 (15%); 16 of 28 allografts (57%) had recurrence of FSGS during the post-transplant period. In Era 1, only 6 of 16 (38%) recurred in the allograft, while 10 of 12 (83%) recurred during Era 2. The odds ratio of recurrence of FSGS in the allograft after induction with anti-IL-2R was 8.3 (95% confidence interval=1.3-52, P =0.02). Only 2 patients in Era 1 received PP, while 10 in Era 2 were entered into an intensive PP protocol followed by maintenance with AB consisting of angiotensin receptor blockers alone, or in combination with angiotensin-converting enzyme inhibitor. Although proteinuria decreased an average of 80±16% with PP, the response was variable and severe morbid edema persisted in poor responders. Maximum benefit occurred with the addition of AB and MMF. After a follow-up of 27±15 months, proteinuria has shown a sustained decrease of 94±8% below baseline. In conclusion, our experience suggests that, with recurrent FSGS, a limited course of PP followed by maintenance therapy with AB and MMF improves symptoms and may preserve allograft function.

Original languageEnglish
Pages (from-to)210-216
Number of pages7
JournalPediatric Nephrology
Volume20
Issue number2
DOIs
StatePublished - Feb 1 2005

Fingerprint

Focal Segmental Glomerulosclerosis
Plasmapheresis
Allografts
Angiotensins
Mycophenolic Acid
Pediatrics
Kidney
Proteinuria
Recurrence
Transplants
Kidney Transplantation
Morbidity
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Edema
Odds Ratio
Maintenance
Confidence Intervals
Therapeutics

Keywords

  • Angiotensin blockade
  • Focal glomerulosclerosis
  • Kidney transplant
  • Nephrotic syndrome

ASJC Scopus subject areas

  • Nephrology
  • Pediatrics, Perinatology, and Child Health

Cite this

Recurrent focal glomerulosclerosis in pediatric renal allografts : The Miami experience. / Hubsch, Hans; Montané, Brenda; Abitbol, Carolyn; Chandar, Jayanthi; Shariatmadar, Sherry; Ciancio, Gaetano; Burke, George W; Miller, Joshua; Strauss, José; Zilleruelo, Gaston E.

In: Pediatric Nephrology, Vol. 20, No. 2, 01.02.2005, p. 210-216.

Research output: Contribution to journalArticle

Hubsch, Hans ; Montané, Brenda ; Abitbol, Carolyn ; Chandar, Jayanthi ; Shariatmadar, Sherry ; Ciancio, Gaetano ; Burke, George W ; Miller, Joshua ; Strauss, José ; Zilleruelo, Gaston E. / Recurrent focal glomerulosclerosis in pediatric renal allografts : The Miami experience. In: Pediatric Nephrology. 2005 ; Vol. 20, No. 2. pp. 210-216.
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abstract = "Recurrence of focal glomerulosclerosis (FSGS) following renal transplantation is a common cause of allograft loss and clinical morbidity. Recent attempts to control proteinuria and morbidity with plasmapheresis (PP) have met with limited success. Our experience with the use of mycophenolate mofetil (MMF) and angiotensin blockade (AB) in the management of refractory FSGS pre transplant suggested its potential benefit in post-transplant recurrence. This report presents our 25-year experience in pediatric renal transplantation of patients with FSGS divided into two treatment eras: Era 1-prior to use of daclizumab (anti-IL-2R) and Era 2-after daclizumab. A total of 179 pediatric patients were transplanted during the 25-year period. FSGS was confirmed in 27 (15{\%}); 16 of 28 allografts (57{\%}) had recurrence of FSGS during the post-transplant period. In Era 1, only 6 of 16 (38{\%}) recurred in the allograft, while 10 of 12 (83{\%}) recurred during Era 2. The odds ratio of recurrence of FSGS in the allograft after induction with anti-IL-2R was 8.3 (95{\%} confidence interval=1.3-52, P =0.02). Only 2 patients in Era 1 received PP, while 10 in Era 2 were entered into an intensive PP protocol followed by maintenance with AB consisting of angiotensin receptor blockers alone, or in combination with angiotensin-converting enzyme inhibitor. Although proteinuria decreased an average of 80±16{\%} with PP, the response was variable and severe morbid edema persisted in poor responders. Maximum benefit occurred with the addition of AB and MMF. After a follow-up of 27±15 months, proteinuria has shown a sustained decrease of 94±8{\%} below baseline. In conclusion, our experience suggests that, with recurrent FSGS, a limited course of PP followed by maintenance therapy with AB and MMF improves symptoms and may preserve allograft function.",
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AU - Shariatmadar, Sherry

AU - Ciancio, Gaetano

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