Prophylactic treatment of FSGS recurrence in patients who relapsed in a previous kidney graft

Charlotte Uro-Coste; Céline Lambert; Vincent Audard; Lionel Couzi; Sophie Caillard; Matthias Büchler; Arnaud Del Bello; Paolo Malvezzi; Vincent Pernin; Charlotte Colosio; Laurent Mesnard; Dominique Bertrand; Frank Martinez; Didier Ducloux; Coralie Poulain; Antoine Thierry; Clément Danthu; Clarisse Greze; Camille Lanaret; Valérie Moal; Alexandre Hertig; Jacques Dantal; Christophe Legendre; Valérie Chatelet; Antoine Sicard; Clément Gosset; Nicolas Maillard; Agnès Duveau; Clémence Petit; Nassim Kamar; Anne-Elisabeth Heng; Dany Anglicheau; Cyril Garrouste

doi:10.1093/ndt/gfae108

Prophylactic treatment of FSGS recurrence in patients who relapsed in a previous kidney graft

Nephrol Dial Transplant. 2024 May 24:gfae108. doi: 10.1093/ndt/gfae108. Online ahead of print.

Authors

Charlotte Uro-Coste¹, Céline Lambert², Vincent Audard³, Lionel Couzi⁴, Sophie Caillard⁵, Matthias Büchler⁶, Arnaud Del Bello⁷, Paolo Malvezzi⁸, Vincent Pernin⁹, Charlotte Colosio¹⁰, Laurent Mesnard¹¹, Dominique Bertrand¹², Frank Martinez¹³, Didier Ducloux¹⁴, Coralie Poulain¹⁵, Antoine Thierry¹⁶, Clément Danthu¹⁷, Clarisse Greze¹, Camille Lanaret¹⁸, Valérie Moal¹⁹, Alexandre Hertig²⁰, Jacques Dantal²¹, Christophe Legendre¹³, Valérie Chatelet²², Antoine Sicard²³, Clément Gosset²³, Nicolas Maillard²⁴, Agnès Duveau²⁵, Clémence Petit²¹, Nassim Kamar⁷, Anne-Elisabeth Heng¹, Dany Anglicheau¹³, Cyril Garrouste¹

Affiliations

¹ Service de Néphrologie, CHU Clermont-Ferrand, Clermont-Ferrand, France.
² Unité de Biostatistiques, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France.
³ Assistance Publique des Hôpitaux de Paris, Service de Néphrologie et Transplantation Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique », Hôpitaux Universitaires Henri-Mondor, Univ Paris Est Créteil, INSERM, IMRB, Créteil, France.
⁴ Service de Néphrologie, Transplantation, Dialyse et Aphérèses, CHU de Bordeaux, Bordeaux, France.
⁵ Service de Néphrologie, University Hospital, Strasbourg, France.
⁶ Service de Néphrologie et Immunologie Clinique, CHRU de Tours, Tours, France.
⁷ Département de Néphrologie et Transplantation d'Organes, CHU Toulouse, INSERM U1043, IFR-BMT, Université Paul Sabatier, Toulouse, France.
⁸ Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France.
⁹ Service de Néphrologie, Dialyse et Transplantation, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France.
¹⁰ Service de Néphrologie et Transplantation, CHU Reims, Reims, France.
¹¹ Assistance Publique - Hôpitaux de Paris, Soins Intensifs Néphrologiques et Rein Aigu, APHP Sorbonne Université, Hôpital Tenon, Paris, France.
¹² Service de Néphrologie, CHRU, Rouen, France.
¹³ Assistance Publique des Hôpitaux de Paris, Service de Néphrologie et Transplantation, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France.
¹⁴ Service de Néphrologie, Dialyse et Transplantation, CHU Besançon, Besançon, France.
¹⁵ Service de Néphrologie-Médecine Interne-Dialyse-Transplantation, CHU d'Amiens, Amiens, France.
¹⁶ Service de Néphrologie-Hémodialyse-Transplantation Rénale, CHU de Poitiers, Poitiers, France.
¹⁷ Service de Néphrologie, Dialyse et Transplantation, CHU Limoges, Limoges, France.
¹⁸ Service de Néphrologie, CH Jacques Lacarin, Vichy, France.
¹⁹ Aix Marseille Université, Assistance Publique Hôpitaux de Marseille, Hôpital Conception, Centre de Néphrologie et Transplantation Rénale, Marseille, France.
²⁰ Service de Néphrologie, Hôpital Foch, Suresnes, France.
²¹ Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie Clinique, CHU Nantes, Nantes, France.
²² Centre Universitaire des Maladies Rénales, Centre Hospitalier Universitaire de Caen, Caen, France.
²³ Service de Néphrologie, Dialyse et Transplantation, CHU Nice, Nice, France.
²⁴ Service de Néphrologie et Transplantation, CHU Saint-Etienne, Saint-Etienne, France.
²⁵ Service de Néphrologie, CHU Angers, Angers, France.

PMID: 38794882
DOI: 10.1093/ndt/gfae108

Abstract

Background and hypothesis: Recurrence of focal segmental glomerulosclerosis (FSGS) is common after kidney transplantation and is classically associated with a significant decrease in graft survival. A major risk factor is a prior history of FSGS recurrence on a previous graft. This analysis reports the impact of a prophylactic treatment of FSGS recurrence in very high-risk patients who experienced a recurrence on a previous graft.

Methods: We performed a retrospective multicentre observational study in 25 French transplantation centres. The inclusion criteria were patients aged more than 18 years who had undergone kidney transplant between December 31, 2004, and December 31, 2020, and who had a history of FSGS recurrence on a previous graft.

Results: We identified 66 patients: 40 received prophylactic treatment (PT+), including intravenous cyclosporine and/or rituximab and/or plasmapheresis, and 26 did not receive any prophylactic treatment (PT-). The time to progression to end-stage kidney disease was similar between groups. The PT + group was younger at FSGS diagnosis and at the time of kidney retransplantation and lost their previous graft faster. The overall recurrence rate was 72.7% (76.9% in the PT- group and 70.0% in the PT + group, P = 0.54). At least partial remission was achieved in 87.5% of patients. The 5-year graft survival was 67.7% (95% CI: 53.4 to 78.4%): 65.1% (95%CI: 48.7 to 77.4%) in patients with FSGS recurrence vs. 77.3% (95% CI: 43.8 to 92.3%) in patients without recurrence (P = 0.48).

Conclusion: Our study suggests that prophylactic treatment should not be used routinely in patients receiving a second transplantation after recurrence of FSGS on a previous graft. The recurrence rate is high regardless of the use of prophylactic treatment. However, the 5-year graft survival remains satisfactory.

Keywords: focal segmental glomerulosclerosis; graft survival; kidney transplantation; prophylactic treatment; recurrent glomerular disease.