Recurrence of the original disease in pediatric renal transplantation

Recurrent disease in the transplanted kidney is extremely common and yet accounts for less than 5% of graft loss in the adult population. In children, however, recurrence of the original disease has been responsible for over 6% of index graft failures and 12% of second graft failures in North America. The diseases that commonly lead to recurrence and consequent graft failure in children are primary glomerulo-nephritides such as focal segmental glomerulosclerosis (FSGS), systemic diseases of which hemolytic uremic syndrome (HUS) is best known for this complication and metabolic diseases of which primary hyperoxaluria (PH) is of importance. With the development of new therapeutic and surgical strategies, none of these conditions are now considered a contraindication for cadaveric (CAD) or living related donor (LRD) transplantation. Recurrent disease has also provided investigators a unique opportunity to study the pathogenesis of glomerular disease.