Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Republic of Korea.
Transplant Proc. 2024 Oct;56(8):1752-1756. doi: 10.1016/j.transproceed.2024.08.026. Epub 2024 Sep 4.
Focal segmental glomerulosclerosis (FSGS) is a notable subtype of glomerulonephritis in kidney transplantation, often resulting in graft failure. Yet, research comparing transplant outcomes between de novo and recurrent FSGS is scarce. This study aims to compare clinical features and transplant outcomes between these two categories.
This retrospective study enrolled 773 kidney transplant recipients from two centers between January 2008 and October 2021. Patients diagnosed with FSGS through graft kidney biopsy were included. They were categorized into two groups based on the time of FSGS occurrence and results of native kidney biopsy: the recurrent FSGS group and the de novo FSGS group.
Of 773 kidney transplant patients, 24 had primary FSGS-causing end-stage renal disease. During a median 65-month follow-up, 5 of these patients developed recurrent FSGS (incidence: 26.3%). Among 749 patients with other kidney diseases causing end-stage renal disease, 9 had de novo FSGS (incidence: 1.2%). In the recurrent FSGS group, 2 out of 5 patients experienced graft failure, with no deaths or acute rejections. Similarly, in the de novo FSGS group, 3 out of 9 patients experienced graft failure, with no deaths or acute rejections. Kaplan-Meier analysis showed slower graft loss in de novo FSGS, resulting in a higher graft survival rate compared to recurrent FSGS (probability of graft survival, 60% vs 33.3%, P = .036).
Graft loss progresses more slowly in de novo FSGS compared to recurrent FSGS, resulting in a higher long-term graft survival rate in de novo FSGS than in recurrent FSGS.
局灶节段性肾小球硬化症（FSGS）是肾移植中一种显著的肾小球肾炎亚型，常导致移植物失功。然而，比较新发 FSGS 和复发性 FSGS 移植结局的研究较少。本研究旨在比较这两种类型的临床特征和移植结局。
本回顾性研究纳入了 2008 年 1 月至 2021 年 10 月期间来自两个中心的 773 例肾移植受者。通过移植肾活检诊断为 FSGS 的患者被纳入研究。根据 FSGS 发生时间和原发性肾病活检结果将患者分为两组：复发性 FSGS 组和新发 FSGS 组。
在 773 例肾移植患者中，24 例因原发性 FSGS 导致终末期肾病。在中位 65 个月的随访期间，这 24 例患者中有 5 例（发生率：26.3%）发展为复发性 FSGS。在 749 例因其他肾脏疾病导致终末期肾病的患者中，9 例（发生率：1.2%）新发 FSGS。在复发性 FSGS 组中，5 例患者中有 2 例发生移植物失功，无死亡或急性排斥反应。同样，在新发 FSGS 组中，9 例患者中有 3 例发生移植物失功，无死亡或急性排斥反应。Kaplan-Meier 分析显示，新发 FSGS 中移植物丢失进展较慢，导致与复发性 FSGS 相比，新发 FSGS 的移植物存活率更高（移植物存活率的概率，60%比 33.3%，P =.036）。
与复发性 FSGS 相比，新发 FSGS 中移植物丢失进展更慢，导致新发 FSGS 的长期移植物存活率高于复发性 FSGS。
