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Mouse Kidney Transplantation: Models of Allograft Rejection
Published on: October 11, 2014
Predictive value of race in post-transplantation recurrence of focal segmental glomerulosclerosis in children
L Butani1, M S Polinsky, B A Kaiser
1Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, PA, USA.
Insights
Focal segmental glomerulosclerosis (FSGS) recurrence post-transplant is high. African-American children had lower FSGS recurrence and better graft survival than other races, suggesting race is a factor in pediatric kidney transplant outcomes.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Renal Pathology
Background:
- Focal segmental glomerulosclerosis (FSGS) is a primary cause of pediatric end-stage renal disease (ESRD).
- High rates of FSGS recurrence after kidney transplantation (Tx) pose a significant challenge.
- The impact of recipient race on FSGS recurrence and graft survival remains under-evaluated.
Purpose of the Study:
- To investigate the association between recipient race and FSGS recurrence after renal transplantation in children.
- To evaluate the impact of FSGS recurrence on graft survival in different racial groups.
Main Methods:
- Retrospective review of pediatric renal transplants for FSGS at St Christopher's Hospital for Children (1971-1997).
- Analysis of demographic data, including recipient race, age at diagnosis, and time to ESRD.
- Comparison of FSGS recurrence rates and graft survival between African-American and other racial groups.
Main Results:
- Twenty patients received 27 allografts for FSGS-related ESRD; 10 (37%) were African-American (AA) and 16 (59%) were Caucasian (C).
- FSGS recurrence was observed in 30% of grafts (8/27).
- FSGS recurrence occurred in 10% of AA recipients (1/10) versus 41% in other racial groups (7/17; P=0.19).
- Graft survival was better in AA recipients with recurrence (1/1 maintained function) compared to other groups (3/7 lost grafts).
Conclusions:
- Recipient race may influence the frequency and impact of FSGS recurrence post-kidney transplantation in children.
- FSGS recurrence posed a greater threat to graft survival in non-African-American recipients.
- Recipient race should be considered in pre-transplant counseling for pediatric FSGS patients.
Background:
Focal segmental glomerulosclerosis (FSGS) is a leading cause of end-stage renal disease (ESRD) in children, and one of the most difficult to manage because of its high recurrence rate post-transplantation (Tx). Several predictive factors have been associated with disease recurrence (DR) although one in particular, the role of recipient race, has not been adequately evaluated. Herein we report our experience with DR in the post-Tx period in eight patients.
Methods:
Records were reviewed for all renal transplants performed at St Christopher's Hospital for Children from 1971 to 1997.
Results:
Twenty patients received 27 allografts for ESRD due to FSGS. Ten (37%) grafts went to African-American (AA) children, and 16 (59%) to those of Caucasian (C) origin. DR was observed in eight (30%) grafts after Tx. No differences were noted between the patients who developed DR and those who did not, with respect to age at diagnosis or time to ESRD. DR was observed in one (10%) of 10 grafts in AA, compared to seven (41%) of 17 grafts in the other (O) racial groups (P=0.19). At last follow-up, the only AA recipient with DR has maintained stable renal function, while three (43%) of seven in O have lost their grafts.
Conclusion:
In conclusion, in our population post-Tx recurrence of FSGS occurred more frequently and represented a greater threat to graft survival in O recipients than in those of AA descent. Recipient race should therefore be taken into consideration during pre-Tx counselling of families of children with FSGS.
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