Predictive value of race in post-transplantation recurrence of focal segmental glomerulosclerosis in children.

nephrotic syndrome in children, approximately oneBackground. Focal segmental glomerulosclerosis third of whom progress to ESRD [2]. In a substantial (FSGS ) is a leading cause of end-stage renal disease proportion, FSGS recurs following Tx, resulting in ( ESRD) in children, and one of the most diYcult to graft loss in about one-half [3‐7]. Predictive factors manage because of its high recurrence rate post- that have been associated with a high risk of DR are transplantation ( Tx). Several predictive factors have a younger age at presentation [6‐8], progression to been associated with disease recurrence (DR) although ESRD within 3 years of disease onset [6,8], and in one in particular, the role of recipient race, has not some reports the identification of mesangial proliferabeen adequately evaluated. Herein we report our tion on native kidney biopsy [3,6,8,9]. The predictive experience with DR in the post-Tx period in eight role of recipient race in recurrence of FSGS has been patients. inadequately addressed. To date, this issue has been Methods. Records were reviewed for all renal trans- investigated in only one report, in which a reduced plants performed at St Christopher’s Hospital for risk of DR was demonstrated in AA [9]. Children from 1971 to 1997. Results. Twenty patients received 27 allografts for ESRD due to FSGS. Ten (37%) grafts went to African- Subjects and methods American (AA) children, and 16 (59%) to those of Caucasian (C ) origin. DR was observed in eight (30%) Records were reviewed for all renal transplants performed grafts after Tx. No diVerences were noted between the at St Christopher’s Hospital for Children from 1971 to 1997. patients who developed DR and those who did not, Children whose native kidney biopsy showed clear evidence with respect to age at diagnosis or time to ESRD. DR of FSGS were identified, and their charts reviewed to obtain was observed in one (10%) of 10 grafts in AA, com- demographic information and data relating to their post-Tx pared to seven (41%) of 17 grafts in the other (O) clinical course. Patients with a histological diagnosis of FSGS racial groups (P=0.19). At last follow-up, the only who presented with ESRD, but without a preceding history AA recipient with DR has maintained stable renal of clinical nephrosis, were excluded from the analysis. DR function, while three (43%) of seven in O have lost was defined as the appearance of nephrotic-range proteinuria their grafts. (>40 mg/h/m2) in the absence of acute or chronic rejection, Conclusion. In conclusion, in our population post-Tx and was confirmed by allograft biopsy. Fisher’s two-tailed recurrence of FSGS occurred more frequently and exact test was used for statistical analysis of diVerences between the cohort of patients with and without DR. represented a greater threat to graft survival in O recipients than in those of AA descent. Recipient race should therefore be taken into consideration during Results pre-Tx counselling of families of children with FSGS.