Response to plasma exchange and graft survival in recurrent focal and segmental glomerulosclerosis after transplantation: does the time of recurrence matter?

Main problem Recurrence of primary focal and segmental glomerulosclerosis following kidney transplantation (rFSGS) is a frequent and severe disease. Methods We studied the time to recurrence of FSGS and its impact on the response to plasma exchange (PE) and graft survival. Results Between 1990 and 2013, 2730 kidney transplants were performed, including 52 patients with a primary diagnosis of FSGS. Of these patients with primary FSGS, 34 (67%) developed rFSGS. We retrospectively divided these patients into two groups depending on the time to recurrence: early (up to three months after transplantation, n=26) or late (more than three months after transplantation, n=8). Survival did not significantly differ between the two groups. In cases of late recurrence, PE was started later, was performed less frequently and remission was achieved after more PE sessions and longer PE treatment than for the early group (p=0.01). In early recurrence, resistance to PE at 40 days was associated with no long-term response to PE. Conclusions PE should be performed as soon as possible after rFSGS. Patients with late rFSGS need to be offered the same treatment regime as those with early rFSGS.