Outcome of renal transplantation in Indian children with primary focal segmental glomerulosclerosis - a single center experience

Recurrence of focal segmental glomerulo-sclerosis (FSGS) following renal transplantat-ion is associated with decreased allograft function and/or graft loss. The optimal specific management of recurrence during the post-transplant period is not yet clear. Plasma-pheresis peri-operatively or following transplantation and other supportive measures such as higher doses of cyclosporine have been used in the clinical management of recurrence. We performed a retrospective analysis of ten children with FSGS who had renal transplants at our center between 1999 and 2008. Following transplantation, four (40%) patients developed recurrence of nephrotic syndrome (NS). We observed heterogeneity in the age at onset of NS, time to reach end-stage renal disease, and age at the time of transplant between those who had and did not have recurrences, but our small sample size precluded any definitive conclusions. All of the four patients were treated with plasmapheresis but the high cost limited the duration of therapy. In addition, they received cyclophosphamide instead of azathioprine or mycophenolate for three months. One patient lost his graft owing to recurrence while two (50%) of the four treated patients recovered completely and one remained proteinuric at the last follow-up. We concluded that recurrence of FSGS after renal transplantation remains an important cause of decreased graft survival and also that the cost of therapy is a limiting factor in providing optimal treatment for recurrence.