Re-transplantation in pediatric patients with failure of primary transplant due to recurrent focal segmental glomerulosclerosis: A pediatric nephrology research consortium study.

Abstract

INTRODUCTION:

Recurrent focal and segmental glomerulosclerosis (FSGS) in kidney transplant recipients is associated with lower graft survival and increased morbidity. There are limited data to guide the decision to re-transplant patients with transplant failure due to FSGS recurrence. We aimed to evaluate outcomes in patients re-transplanted after having initial graft failure due to recurrent FSGS and to study physician attitudes and practice patterns.

METHODS:

Retrospective data from 10 centers were collected on 20 patients transplanted between January 1997 and September 2018. A survey was sent to nephrologist members of the Pediatric Nephrology Research Consortium.

RESULTS:

Mean patient age (years) was 9.8 ± 4.8 at first transplant and 15.9 ± 4.9 at re-transplantation. Pre-transplant plasmapheresis was used in 1 (5.3%) primary transplant vs. 7 (38.9%) re-transplants (p = .03). Nephrotic syndrome recurred in 14 patients (70%) after re-transplantation and was severe in 21.1% vs. 64.7% after first transplant (p = .04). Graft survival was significantly higher in the second transplant (p .009) with 70% having functioning grafts at a median of 25.2 months. Thirty-one physicians from 21 centers completed the survey, 94% indicated they would re-transplant such patients, 44.4% preferred a minimum waiting period before re-transplantation, 36.4% preferred living donors, and 22.2% indicated having protocols for re-transplantation at their centers.

CONCLUSIONS:

Consideration for re-transplantation is high among pediatric nephrologists. Pre-transplant plasmapheresis was more frequent in re-transplanted patients. Nephrotic syndrome recurrence was less severe, with better graft survival. More data and a larger population are necessary to further evaluate outcome determinants and best practices in this special population.

• Authors: Aesha Maniar, David K Hooper, Christine B Sethna, Pamela Singer, Avram Traum, Elizabeth Benoit, Elizabeth Kotzen, Priya Verghese, Rouba Garro, Margaret Kamel, Daniel Ranch, Weiwen Shih, Namrata G Jain, Samhar Al-Akash
• Journal: Pediatric transplantation (Pediatr Transplant) Vol. 25 Issue 7 Pg. e14085 (Nov 2021) ISSN: 1399-3046 [Electronic] Denmark
• PMID: 34247442 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © 2021 Wiley Periodicals LLC.

Topics

• Child
• Child, Preschool
• Female
• Glomerulosclerosis, Focal Segmental (surgery)
• Graft Rejection (surgery)
• Humans
• Kidney Transplantation
• Male
• Plasmapheresis
• Postoperative Complications (surgery)
• Practice Patterns, Physicians' (statistics & numerical data)
• Reoperation (statistics & numerical data)
• Retrospective Studies
• Surveys and Questionnaires