Post-transplant recurrence of focal segmental glomerular sclerosis: consensus statements

Rupesh Raina; Swathi Jothi; Dieter Haffner; Michael Somers; Guido Filler; Prabhav Vasistha; Ronith Chakraborty; Ron Shapiro; Parmjeet S Randhawa; Rulan Parekh; Christopher Licht; Timothy Bunchman; Sidharth Sethi; Guneive Mangat; Joshua Zaritsky; Franz Schaefer; Bradley Warady; Sharon Bartosh; Mignon McCulloch; Khalid Alhasan; Agnieszka Swiatecka-Urban; William E Smoyer; Anil Chandraker; Hui Kim Yap; Vivekanand Jha; Arvind Bagga; Jai Radhakrishnan

doi:10.1016/j.kint.2023.10.017

Post-transplant recurrence of focal segmental glomerular sclerosis: consensus statements

Kidney Int. 2024 Mar;105(3):450-463. doi: 10.1016/j.kint.2023.10.017. Epub 2023 Dec 22.

Authors

Rupesh Raina¹, Swathi Jothi², Dieter Haffner³, Michael Somers⁴, Guido Filler⁵, Prabhav Vasistha², Ronith Chakraborty¹, Ron Shapiro⁶, Parmjeet S Randhawa⁷, Rulan Parekh⁸, Christopher Licht⁹, Timothy Bunchman¹⁰, Sidharth Sethi¹¹, Guneive Mangat², Joshua Zaritsky¹², Franz Schaefer¹³, Bradley Warady¹⁴, Sharon Bartosh¹⁵, Mignon McCulloch¹⁶, Khalid Alhasan¹⁷, Agnieszka Swiatecka-Urban¹⁸, William E Smoyer¹⁹, Anil Chandraker²⁰, Hui Kim Yap²¹, Vivekanand Jha²², Arvind Bagga²³, Jai Radhakrishnan²⁴

Affiliations

¹ Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, Ohio, USA; Department of Nephrology, Akron Children's Hospital, Akron, Ohio, USA.
² Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, Ohio, USA.
³ Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.
⁴ Division of Nephrology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁵ Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
⁶ Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, New York, USA.
⁷ Department of Pathology, Thomas E Starzl Transplant Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
⁸ Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
⁹ Division of Pediatric Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
¹⁰ Pediatric Nephrology and Transplantation, Children's Hospital of Richmond at Virginia Commonwealth University (VCU), Richmond, Virginia, USA.
¹¹ Pediatric Nephrology, Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, India.
¹² Division of Pediatric Nephrology, Nemours, A.I. duPont Hospital for Children, Wilmington, Delaware, USA.
¹³ Department of Pediatric Nephrology, University Children's Hospital Heidelberg, Heidelberg, Germany.
¹⁴ Division of Nephrology, University of Missouri-Kansas City School of Medicine, Children's Mercy, Kansas City, Missouri, USA.
¹⁵ Department of Pediatrics, University of Wisconsin Medical School, Madison, Wisconsin, USA.
¹⁶ Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
¹⁷ Nephrology Unit, Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pediatric Kidney Transplant Division, Organ Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
¹⁸ University of Virginia Children's Hospital, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
¹⁹ Center for Clinical and Translational Research and Division of Nephrology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA.
²⁰ Transplantation Research Center, Kidney and Pancreas Transplantation, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
²¹ Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore.
²² George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India; School of Public Health, Imperial College, London, UK; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
²³ Division of Pediatric Nephrology, All India Institute of Medical Sciences, New Delhi, India.
²⁴ Department of Medicine (Nephrology), Columbia University Medical Center, New York, New York, USA. Electronic address: jr55@cumc.columbia.edu.

PMID: 38142038
DOI: 10.1016/j.kint.2023.10.017

Abstract

Focal segmental glomerular sclerosis (FSGS) is 1 of the primary causes of nephrotic syndrome in both pediatric and adult patients, which can lead to end-stage kidney disease. Recurrence of FSGS after kidney transplantation significantly increases allograft loss, leading to morbidity and mortality. Currently, there are no consensus guidelines for identifying those patients who are at risk for recurrence or for the management of recurrent FSGS. Our work group performed a literature search on PubMed/Medline, Embase, and Cochrane, and recommendations were proposed and graded for strength of evidence. Of the 614 initially identified studies, 221 were found suitable to formulate consensus guidelines for recurrent FSGS. These guidelines focus on the definition, epidemiology, risk factors, pathogenesis, and management of recurrent FSGS. We conclude that additional studies are required to strengthen the recommendations proposed in this review.

Keywords: focal segmental glomerular sclerosis; plasmapheresis; post-transplant.

Publication types

Review

MeSH terms

Adult
Child
Glomerulosclerosis, Focal Segmental* / diagnosis
Glomerulosclerosis, Focal Segmental* / epidemiology
Glomerulosclerosis, Focal Segmental* / etiology
Humans
Kidney Transplantation* / adverse effects
Nephrotic Syndrome* / diagnosis
Nephrotic Syndrome* / etiology
Nephrotic Syndrome* / therapy
Plasmapheresis
Recurrence
Sclerosis / complications
Transplantation, Homologous / adverse effects

Grants and funding

R01 HL144539/HL/NHLBI NIH HHS/United States