Ferreira da Mata G, Mansur J B, Riguetti M T P, Rezende G F, Osmar de Medina Pestana J, Mastroianni Kirsztajn G
Department of Medicine (Nephrology), Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
Faculty of Medicine, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Brazil.
Int J Organ Transplant Med. 2021;12(3):1-10.
Focal segmental glomerulosclerosis (FSGS) has a high recurrence rate after renal transplantation, which significantly impacts renal graft survival. However, the factors related to recurrence remain unclear.
This study aimed to analyze focal segmental recurrence and evolution of glomerulosclerosis after renal transplantation.
This was a descriptive, retrospective study involving 88 adults who underwent renal transplantation within a 15-year period. Demographic and clinical characteristics, as well as the occurrence of graft loss, were analyzed. Over the study period, 88 patients with a diagnosis of FSGS after transplantation were identified.
The mean age of the patients (n=54, males) was 29.1 years. Transplants with deceased donors predominated (60.9%). Calcineurin and prednisone inhibitors were present in 96.4% of the initial immunosuppression regimens. The mean time of onset of proteinuria greater than 0.5 g/g was 20.51 days. At 60 months after transplantation, 44.16% of the patients had partial remission, 25.97% had complete remission, and 29.87% had no remission. However, 50.60% of the patients developed graft loss throughout the analyzed period. Eight patients (9.4%) died within 60 months, of which five (62.5%) were attributed to infection.
Our results indicate that FSGS after renal transplantation is a disease of high recurrence that is commonly precocious, and the histological alterations in light microscopy are not simultaneous to the appearance of proteinuria. Hypertension is considered a risk factor causing progression and recurrence. Thus, prospective studies are required to better evaluate progression and recurrence factors.
局灶节段性肾小球硬化症（FSGS）在肾移植后复发率较高，这对肾移植存活产生了显著影响。然而，与复发相关的因素仍不清楚。
本研究旨在分析肾移植后局灶节段性肾小球硬化症的复发及演变情况。
这是一项描述性回顾性研究，纳入了15年内接受肾移植的88名成年人。分析了人口统计学和临床特征以及移植肾丢失的发生情况。在研究期间，共确定了88例移植后诊断为FSGS的患者。
患者（n = 54，男性）的平均年龄为29.1岁。死亡供者肾移植占主导（60.9%）。96.4%的初始免疫抑制方案中使用了钙调神经磷酸酶抑制剂和泼尼松。蛋白尿大于0.5 g/g的平均发病时间为20.51天。移植后60个月时，44.16%的患者部分缓解，25.97%的患者完全缓解，29.87%的患者未缓解。然而，在整个分析期间，50.60%的患者出现了移植肾丢失。8例患者（9.4%）在60个月内死亡，其中5例（62.5%）归因于感染。
我们的结果表明，肾移植后FSGS是一种复发率高且通常发病较早的疾病，光镜下的组织学改变与蛋白尿的出现不同步。高血压被认为是导致病情进展和复发的危险因素。因此，需要进行前瞻性研究以更好地评估病情进展和复发因素。
