Skip to main content
Log in

Living-related donor transplants should be performed with caution in patients with focal segmental glomerulosclerosis

  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

The success rates of living-related donor (LRD) transplants are clearly superior to those obtained with cadaver donors. However, caution should be exercised when considering LRD transplantation for a condition which has an increased chance of recurring after transplantation and causing ultimate graft failure. The recurrence rate of focal segmental glomerulosclerosis (FSGS) in the allograft is 20%–40%, with graft failure resulting in 40%–50% of these cases. However, these figures may be an underestimation of the true rate of recurrence of FSGS. Once a first transplant fails due to recurrent disease, the risk of recurrence in the second transplant approaches 80%. Subgroups of patients at high risk for recurrence have been identified. In patients not at high risk for recurrent FSGS, the use of a LRD should be considered, provided that the donor and recipient and their families have been informed that the disease may recur and lead to graft failure. In patients at high risk for recurrence, a LRD transplant should be avoided. Hopefully, future development of a simple and reliable test to predict the likelihood of recurrence will enable us to counsel and advise our patients with FSGS about the wisdom or dangers of proceeding with a LRD transplant.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Glassock RJ, Feldman D, Reynolds ES, Dammin GJ, Merrell JP (1968) Human renal isografts: a clinical and pathological analysis. Medicine (Baltimore) 47: 411–454

    Article  CAS  Google Scholar 

  2. Mathew TM (1988) Recurrence of disease after renal transplantation. Am J Kidney Dis 12: 85–96

    PubMed  CAS  Google Scholar 

  3. O'Meara Y, Green A, Carmody M, Donohoe J, Campbell E, Browne O, Walshe J (1989) Recurrent glomerulonephritis in renal transplants: fourteen years experience. Nephrol Dial Transplant 4: 730–734

    PubMed  Google Scholar 

  4. Schwarz A, Kraus P-H, Offerman G, Keller F (1991) Recurrent and de novo renal disease after kidney transplantation with or without cyclosporine A. Am J Kidney Dis 17: 524–531

    PubMed  CAS  Google Scholar 

  5. Cameron JS (1991) Recurrent primary disease and de novo nephritis following renal transplantation. Pediatr Nephrol 5: 412–421

    Article  PubMed  CAS  Google Scholar 

  6. Hoyer JR, Vernier RL, Najarian JS, Raij L, Simmons RL, Michael AF (1972) Recurrence of idiopathic nephrotic syndrome after transplantation. Lancet II: 343–348

    Article  Google Scholar 

  7. Mathew TH, Mathews DC, Hobbs JB, Kincaid-Smith P (1975) Glomerular lesions after renal transplantation. Am J Med 59: 177–190

    Article  PubMed  CAS  Google Scholar 

  8. Leumann EP, Briner J, Donckerwolckke RAM, Kuijten R, Largiader F (1980) Recurrence of focal segmental glomerulosclerosis in the transplanted kidney. Nephron 25: 65–71

    Article  PubMed  CAS  Google Scholar 

  9. Cheigh JS, Mouradian J, Susin M, Stubenbord WT, Tapia L, Riggio RR, Stenzel KH, Rubin AL (1980) Kidney transplant nephrotic syndrome: relationship between allograft histopathology and natural course. Kidney Int 18: 358–365

    Article  PubMed  CAS  Google Scholar 

  10. Cheigh JS, Mouradian J, Soliman M, Tapia L, Riggio RR, Stenzel KH, Rubin AL (1983) Focal segmental glomerulosclerosis in renal transplants. Am J Kidney Dis 2: 449–455

    PubMed  CAS  Google Scholar 

  11. Maizel SE, Sibley RK, Horstman JP, Kjellstrand CM, Simmons RL (1981) Incidence and significance of recurrent focal segmental glomerulosclerosis in renal allograft recipients. Transplantation 32: 512–516

    Article  PubMed  CAS  Google Scholar 

  12. Morzycka M, Croker BP, Seigler HF, Tisher CC (1982) Evaluation of recurrent glomerulonephritis in kidney allografts. Am J Med 72: 588–598

    Article  PubMed  CAS  Google Scholar 

  13. Cameron JS (1982) Glomerulonephritis in renal transplants. Transplantation 34: 237–245

    Article  PubMed  CAS  Google Scholar 

  14. Cheigh JS, Mouradian J Soliman M, Tapia L, Riggio RR, Stenzel KH, Rubin AL (1983) Focal segmental glomerulosclerosis in renal transplants. Am J Kidney Dis 2: 449–455

    PubMed  CAS  Google Scholar 

  15. Honkanen E, Tornroth T, Pettersson E, Kulhback B (1984) Glomerulonephritis in renal allografts: results of 18 years of transplantations. Clin Nephrol 21: 210–219

    PubMed  CAS  Google Scholar 

  16. Axelsen RA, Seymour AE, Mathew TH, Fisher G, Canny A, Pascoe V (1984) Recurrent focal glomerulosclerosis in renal transplants. Clin Nephrol 21: 110–114

    PubMed  CAS  Google Scholar 

  17. Striegel JE, Sibley RK, Fryd DS, Mauer M (1986) Recurrence of focal segmental sclerosis in children following renal transplantation. Kidney Int 30: S44-S50

    Google Scholar 

  18. Habib R, Antignac C, Hinglais N, Gagnadoux M-F, Broyer M (1987) Glomerular lesions in the transplanted kidney in children. Am J Kidney Dis 10: 198–207

    PubMed  CAS  Google Scholar 

  19. Vincenti F, Biava C, Tomlanovich S, Amend WJC, Garovoy M, Melzer J, Feduska N, Salvatierra O (1989) Inability of cyclosporine to completely prevent the recurrence of focal glomerulosclerosis after kidney transplantation. Transplantation 47: 595–598

    Article  PubMed  CAS  Google Scholar 

  20. Senguttuvan P, Cameron JS, Hartley RB, Rigden S, Chantler C, Haycock G, Williams DG, Ogg C, Koffman G (1990) Recurrence of focal segmental glomerulosclerosis in transplanted kidneys: analysis of incidence and risk factors in 59 allografts. Pediatr Nephrol 4: 21–28

    Article  Google Scholar 

  21. Banfi G, Colturi C, Montagnino G, Ponticelli C (1990) The recurrence of focal segmental glomerulosclerosis in kidney transplant recipients treated with cyclosporine. Transplantation 50: 594–596

    Article  PubMed  CAS  Google Scholar 

  22. Dantal J Baatard R, Hoorman M, Cantarovich D, Buzelin F, Soulillou JP (1991) Recurrent nephrotic syndrome following renal transplantation in patients with focal glomerulosclerosis. Transplantation 52: 827–831

    Article  PubMed  CAS  Google Scholar 

  23. Broyer M, Selwood N, Brunner F (1992) Recurrence of primary renal disease on kidney graft: a European pediatric experience. J Am Soc Nephrol 2 [Suppl 3]: S255-S257

    PubMed  CAS  Google Scholar 

  24. Artero M, Biava C, Amend W, Tomlanovich S, Vincenti F (1992) Recurrent focal glomerulosclerosis: natural history and response to therapy. Am J Med 92: 375–383

    Article  PubMed  CAS  Google Scholar 

  25. Tejani A, Stablein DH (1992) Recurrence of focal segmental glomerulosclerosis posttransplantation: a special report of the North American Pediatric Renal Transplant Cooperative Society. J Am Soc Nephrol 2 [Suppl 3]: S256-S263

    Google Scholar 

  26. Cameron JS (1993) Recurrent disease in renal allografts. Kidney Int 44 [Suppl 43]: S91-S94

    Google Scholar 

  27. Neumayer H-H, Kienbaum M, Graf S, Schreiber M, Mann JFE, Luft FC (1993) Prevalence and long-term outcome of glomerulonephritis in renal allografts. Am J Kidney Dis 22: 320–325

    PubMed  CAS  Google Scholar 

  28. Opelz G (1992) Collaborative Transplant Study: 10-year report. Transplant Proc 24: 2342–2355

    PubMed  CAS  Google Scholar 

  29. Koyama H, Cecka JM (1993) Rejection episodes. In: Terasaki PI, Cecka JM (eds) Clinical Transplants 1992. Los Angeles, UCLA Tissue Typing Laboratory, pp 391–403

    Google Scholar 

  30. Ismail-Allouch M, Burke G, Nery J, Roth D, Esquenazi V, Ruiz P, Miller J (1993) Rapidly progressive focal segmental glomerulosclerosis occurring in a living related kidney transplant donor. Case report and review of 21 cases of kidney transplants for primary FSGS. Transplant Proc 25: 2176–2177

    PubMed  CAS  Google Scholar 

  31. Ingulli E, Tejani A (1991) Incidence, treatment, and outcome of recurrent focal segmental glomerulosclerosis post-transplantation in 42 allografts in children — a single-center experience. Transplantation 51: 401–405

    Article  PubMed  CAS  Google Scholar 

  32. Stephanian E, Matas AJ, Mauer M, Chavers B, Nevins T, Kashtan C, Sutherland DER, Gores P, Najarian JS (1992) Recurrence of disease in patients retransplanted for focal segmental glomerulosclerosis. Transplantation 53: 755–757

    Article  PubMed  CAS  Google Scholar 

  33. Zimmerman SW (1984) Increased urinary protein excretion in the rat produced by serum from a patient with recurrent focal glomerular sclerosis after renal transplantation. Clin Nephrol 22: 32–38

    PubMed  CAS  Google Scholar 

  34. Artero M, Sharma R, Savin V, Vincenti F (1991) Association of recurrent focal glomerulosclerosis (FGS) with increased albumin permeability of glomeruli incubated with patient sera (abstract). J Am Soc Nephrol 2: 791

    Google Scholar 

  35. Savin VJ (1993) Mechanisms of proteinuria in noninflammatory glomerular diseases. Am J Kidney Dis 21: 347–362

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

First, M.R. Living-related donor transplants should be performed with caution in patients with focal segmental glomerulosclerosis. Pediatr Nephrol 9 (Suppl 1), S40–S42 (1995). https://doi.org/10.1007/BF00867682

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00867682

Key words

Navigation