Improved Transplant Outcomes for Children with FSGS

Children with focal segmental glomerulosclerosis (FSGS) who undergo kidney transplantation are at high risk of recurrent disease and allograft failure. A new study provides insights into long-term posttransplant survival for this group of patients.

The retrospective study in American Journal of Kidney Diseases included 12,303 pediatric patients receiving a first kidney transplant from 1990 through 2009, identified from the US Renal Data System database. In 11% of patients, FSGS was the primary cause of end stage renal disease. All-cause mortality and allograft loss were compared for patients with FSGS versus other causes.

All-cause mortality for children with FSGS improved significantly from the 1990s to the 2000s: from 12.24 to 6.72 deaths per 1000 patient-years, hazard ratio (HR) 0.55. These children also had a smaller but still significant reduction in allograft loss: 75.91 versus 89.05 events/1000 patient-years, HR 0.85.

With adjustment for baseline characteristics at transplantation, mortality was similar for children with and without FSGS. That was so despite higher rates of allograft loss for those with FSGS: HR 1.27 in the 1990s and 1.17 in the 2000s. But additional analysis of children transplanted in the 2000s, adjusted for allograft failure as a time-varying covariate, found lower mortality in the FSGS group: HR 0.70.

The results showed that survival improved for children and adolescents with FSGS undergoing kidney transplantation from the 1990s to the 2000s. In the more recent period studied, the 2000s, posttransplant survival for children with FSGS was similar to that for children without FSGS, and may be even better after adjustment for allograft failure.

“This suggested that allograft loss is a potential mediator of patient survival in FSGS, and that a focus on interventions to decrease allograft loss due to disease recurrence may improve patient survival,” the investigators conclude.

February 2018 (Vol. 10, Number 2)

References

1. Wang C-s et al. Mortality and allograft loss trends among US pediatric kidney transplant recipients with and without focal segmental glomerulosclerosis. Am J Kidney Dis 2017; doi: 10.1053/j.ajkd.2017.09.025