Sharief Shimi, Mahesh Shefali, Del Rio Marcela, Telis Vivian, Woroniecki Robert P
Department of Pediatric Nephrology, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
Int J Nephrol. 2011;2011:506805. doi: 10.4061/2011/506805. Epub 2011 Jun 15.
Recurrence of focal segmental glomerulosclerosis (FSGS) after renal transplantation impacts long-term graft survival and limits access to transplantation. We hypothesized that HLA donor/recipient matching could be used as a surrogate marker of recurrence. In a retrospective study of 42 pediatric and 77 adult subjects with primary FSGS, transplanted from 1990 to 2007 at a single center, we analyzed the degree of donor/recipient HLA compatibility and other clinical variables associated with FSGS recurrence. There were total of 131 allografts for primary FSGS (11 subjects were transplanted twice, and 1 had a third allograft) with 20 cases of FSGS recurrence (17 children) in the primary allograft, and two children who had FSGS recurrence in the second allograft. Fifty-two subjects (40%) were African American, and 66 (50%) Caucasians. Recurrent FSGS and controls were not different for age at transplant, gender, donor source, acute/chronic rejection episodes, and HLA matches. Recurrent FSGS was not associated with HLA mismatches; power equals 83%. Immunosuppressive regimen had no effect on recurrence of FSGS, P = .75. Recurrent FSGS is not associated with HLA mismatching, acute cellular or vascular rejection, and occurs primarily in the pediatric population.
肾移植后局灶节段性肾小球硬化（FSGS）的复发影响移植肾的长期存活，并限制了移植的可及性。我们推测人类白细胞抗原（HLA）供受者匹配可作为复发的替代标志物。在一项对1990年至2007年于单一中心接受移植的42例儿科和77例成人原发性FSGS患者的回顾性研究中，我们分析了供受者HLA相容性程度以及与FSGS复发相关的其他临床变量。共有131例原发性FSGS的同种异体移植（11例患者接受了两次移植，1例接受了第三次移植），其中原发性同种异体移植中有20例FSGS复发（17例儿童），另有两名儿童在第二次同种异体移植中出现FSGS复发。52例受试者（40%）为非裔美国人，66例（50%）为白种人。复发性FSGS患者与对照组在移植时的年龄、性别、供体来源、急/慢性排斥反应发作次数以及HLA匹配情况方面并无差异。复发性FSGS与HLA错配无关；检验效能为83%。免疫抑制方案对FSGS的复发无影响，P = 0.75。复发性FSGS与HLA错配、急性细胞性或血管性排斥反应无关，且主要发生在儿科人群中。
