Demographics and response to therapeutic plasma exchange in pediatric renal transplantation for focal glomerulosclerosis: a single center experience.
Recurrence of FSGS following renal transplantation in pediatric patients is reported as 20-57%. Records of 37 pediatric patients transplanted for FSGS between 1990 and 2005 at a single center were reviewed. Recurrence of disease was assessed by nephrotic range proteinuria and/or FSGS on biopsy. Response to TPE was defined as urine protein to creatinine ratio <0.2. Forty-nine percent of patients were African American, 38% were Caucasian. Fifty-four percent received kidneys from deceased donors and 46% from live donors. Seven patients received preemptive TPE prior to transplantation. Two of these seven patients recurred in the transplanted kidney (28%). Recurrent FSGS occurred in 16 of 37 patients (46%), all of whom received TPE. Recurrence occurred within one month in 12 of 37 patients (32%); eight remitted with TPE (67%). Four of 12 patients failed to respond to TPE. Four of 37 patients (14%) recurred more than one month after transplantation and underwent TPE; three-fourths of patients remitted (75%). Twenty-one of 37 patients (54%) did not recur. One and five yr graft survivals were 84% and 67%, respectively. Median graft survival was 6.7 yr (5.2-10.3). Despite recurrence, FSGS patients can achieve sustained graft function.
Mahesh
Shefali
S
Pediatric Nephrology, Children's Hospital at Montefiore, Bronx, New York 10467, USA.
Del Rio
Marcela
M
Feuerstein
Dianne
D
Greenstein
Stuart
S
Schechner
Richard
R
Tellis
Vivian
V
Kaskel
Frederick
F
D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D005006:Ethnicity; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000208:ethnology / Q000628:therapy*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D010951:Plasma Exchange; D012008:Recurrence; D016896:Treatment Outcome
D007166:Immunosuppressive Agents