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Disease Recurrence-The Sword of Damocles in Kidney Transplantation for Primary Focal Segmental Glomerulosclerosis

Katrin Kienzl-Wagner1, Siegfried Waldegger2, Stefan Schneeberger1

  • 1Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria.

Frontiers in Immunology
|August 6, 2019
PubMed

Insights

Recurrent focal segmental glomerulosclerosis (FSGS) after kidney transplant is common. B-cell therapies show promise for managing this condition, potentially by targeting a circulating permeability factor.

Area of Science:

  • Nephrology
  • Transplantation Immunology

Background:

  • Primary focal segmental glomerulosclerosis (FSGS) poses a significant risk of recurrence in kidney transplant recipients.
  • Recurrent FSGS affects a substantial proportion of kidney grafts, particularly in patients with prior graft loss due to the disease.

Purpose of the Study:

  • To review current knowledge on permeability factors implicated in FSGS pathogenesis.
  • To discuss management strategies for recurrent FSGS, focusing on B-cell related therapies and graft salvage.

Main Methods:

  • Review of clinical and experimental evidence supporting the role of circulating permeability factors in FSGS.
  • Analysis of treatment options for recurrent FSGS, including plasma exchange and B-cell depletion.

Main Results:

  • Evidence suggests a circulating permeability factor mediates FSGS, though the agent remains unidentified.
  • B-cell depleting antibodies demonstrate effectiveness in managing recurrent FSGS, indicating a potential B-cell link.

Conclusions:

  • Profound B-cell depletion before transplantation may prevent recurrence.
  • Salvaging a kidney allograft affected by recurrent FSGS via transfer to a second recipient is a potential strategy.
Keywords:
allograft transferfocal segmental glomerulosclerosiskidney transplantationmanagementprimary FSGSrecurrencerecurrent FSGS

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