Focal segmental glomerulosclerosis (FSGS) is known to recur in some patients after
renal transplantation. Over a prolonged period, we followed 13 pediatric patients with FSGS who had undergone
transplantation from living-related donors, analyzing risk factors for recurrent disease. Native
nephrectomies were performed bilaterally in all patients at least 1 month prior to
transplantation. Immunosuppressive therapy consisted of
cyclosporine (CyA),
mizoribine,
prednisone, and antilymphocytic
globulin or
deoxyspergualin. We examined age at onset, time in months between diagnosis and end-stage disease (dialysis or
transplantation), the duration of dialysis, age at
transplantation, time since
nephrectomy, doses of
immunosuppressive agents, and HLA mismatch. Five patients (42.8%) developed recurrent disease in the graft; all showed
proteinuria within 24 h of
transplantation. However, all allografts have functioned well for 34-156 months following
transplantation despite the recurrences, although 1 of these patients now shows
proteinuria. The remaining 8 patients have had no recurrence for 104.6+/-30.4 months (mean+/-SD). The serum level of
creatinine in patients with recurrence and without recurrence was 1.1+/-0.42 mg/dl and 0.98+/-0.29 mg/dl, respectively. The interval from diagnosis to initiation of dialysis was significantly shorter in patients with recurrence than those without recurrence ( P<0.05), but no other variables differed between these two groups. No recurrence of FSGS was observed in the protocol biopsy at 100 days after
transplantation. We believe that CyA and native
nephrectomy may limit or reverse progression of recurrent FSGS in renal allografts of Japanese pediatric patients, although this is a limited study.