ESPN 51th Annual Meeting

ESPN 2018


 
TRANSPLANTATION IN FSGS: EXPERIENCE OF A HIGH VOLUME CENTER FROM TURKEY
MUSTAFA KOYUN 1 ELIF COMAK 1 GULSAH KAYA AKSOY 1 SEMA AKMAN 1

1- AKDENIZ UNIVERSITY, MEDICAL FACULTY, DEPARTMENT OF PEDIATRICS, DIVISION OF PEDIATRIC NEPHROLOGY, ANTALYA, TURKEY
 
Introduction:

Kidney transplantation (tx) of children with Focal Segmental Glomerulosclerosis (FSGS) is a challenge, because of high recurrence rate, especially immediately after tx. The factors associated with FSGS recurrence is not well defined. We aimed to search for recurrence rate and risk factors for FSGS recurrence at our center.

Material and methods:

In this retrospective study, the records of pediatric renal tx recipients with a primary diagnosis of FSGS were evaluated. We mainly focused on FSGS recurrence within the first month of tx (early recurrence).

Results:

A total of 46 children, 23 boys (50%), with a mean age of 10.3 ± 4.4 years at the time of tx, were included. 37 (80.4%) of transplants had living-related donors; 14 (30.4%) were pre-emptive. 16 (34.8%) had genetic mutations leading to FSGS (9 podocin, 7 other mutations). 6 (13%) patients who were transplanted before May 2008 underwent 2-5 sessions of plasmapheresis prior to kidney tx; 18 (39.1%) underwent bilateral nephrectomies due to massive proteinuria and hypoalbuminemia. Early recurrence developed in 8 patients (17.4%); recurrence rate was 23.3% when patients with genetic FSGS were excluded. Pre-transplant plasmapheresis was not found to be effective to prevent recurrence. Age at tx, gender, donor type and pre-emptive vs dialysis was not found to be associated with recurrence rate. Recurrence rate was more in patients with bilateral nephrectomies compared to that without (38.9% vs 4.0%, p=0.009). Patients with serum albumin < 3 g/dL at the time of tx had more recurrence than albumin >3 g/dL (42.8% vs 6.3%, respectively, p=0.003). Also, mean serum albumin level of patients with recurrence had lower than that without recurrence (2.5±0.7 vs 3.7±0.8 g/dL, respectively, p=0.003).

Conclusions:

We found that bilateral nephrectomies and hypoalbuminemia at the time of transplantation, an indicator of active disease, correlated with early recurrence in children with FSGS. We suggest to wait for transplantation in children with active disease of FSGS until serum albumin rise above 3 g/dL.