Re-transplantation in pediatric patients with failure of primary transplant due to recurrent focal segmental glomerulosclerosis: A pediatric nephrology research consortium study

• Type of Material: Article
• Authors: Aesha Maniar, Cohen Children’s Medical Center; David K David, University of Cincinnati; Christine B Sethna, Cohen Children’s Medical Center; Pamela Singer, Cohen Children’s Medical Center; Avram Traum, Boston Childrens Hospital; Elizabeth Benoit, Boston Childrens Hospital; Elizabeth Kotzen, University of North Carolina; Priya Verghese, Ann and Robert H. Lurie Children’s Hospital; Rouba Garro, Emory University; Margaret Kamel, Emory University; Daniel Ranch, University of Texas Health Science Center; Weiwen Shih, C.S. Mott Children’s Hospital; Namrata G Jain, Columbia University; Samhar Al-Akash, Driscoll Children’s Hospital
• Language: English
• Date: 2021-07-11
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 Wiley Periodicals LLC
• Final Published Version (URL): http://dx.doi.org/10.1111/petr.14085
• Title of Journal or Parent Work: PEDIATRIC TRANSPLANTATION
• Volume: 25
• Issue: 7
• Start Page: e14085
• End Page: e14085
• Keywords: Transplantation; GRAFT FAILURE; graft survival; GLOMERULONEPHRITIS; HIGH-RISK; PLASMAPHERESIS; QUALITY-OF-LIFE; nephrotic syndrome; re-transplantation; Life Sciences & Biomedicine; KIDNEY-TRANSPLANT; Science & Technology; PERMEABILITY; recurrence of FSGS; plasmapheresis; NEPHROTIC SYNDROME; CHILDREN; Pediatrics; FSGS

Abstract

Introduction: Recurrent focal and segmental glomerulosclerosis (FSGS) in kidney transplant recipients is associated with lower graft survival and increased morbidity. There are limited data to guide the decision to re-transplant patients with transplant failure due to FSGS recurrence. We aimed to evaluate outcomes in patients re-transplanted after having initial graft failure due to recurrent FSGS and to study physician attitudes and practice patterns. Methods: Retrospective data from 10 centers were collected on 20 patients transplanted between January 1997 and September 2018. A survey was sent to nephrologist members of the Pediatric Nephrology Research Consortium. Results: Mean patient age (years) was 9.8 ± 4.8 at first transplant and 15.9 ± 4.9 at re-transplantation. Pre-transplant plasmapheresis was used in 1 (5.3%) primary transplant vs. 7 (38.9%) re-transplants (p =.03). Nephrotic syndrome recurred in 14 patients (70%) after re-transplantation and was severe in 21.1% vs. 64.7% after first transplant (p =.04). Graft survival was significantly higher in the second transplant (p.009) with 70% having functioning grafts at a median of 25.2 months. Thirty-one physicians from 21 centers completed the survey, 94% indicated they would re-transplant such patients, 44.4% preferred a minimum waiting period before re-transplantation, 36.4% preferred living donors, and 22.2% indicated having protocols for re-transplantation at their centers. Conclusions: Consideration for re-transplantation is high among pediatric nephrologists. Pre-transplant plasmapheresis was more frequent in re-transplanted patients. Nephrotic syndrome recurrence was less severe, with better graft survival. More data and a larger population are necessary to further evaluate outcome determinants and best practices in this special population.