Single Center Contribution to the Recurrence Rate and Treatment Options of Post-transplant Focal Segmental Glomerulosclerosis

Background. Post-transplant Focal Segmental Glomerulosclerosis (FSGS) recurrence, the third cause of graft failure in the first year, and its treatment still remains an open challenge. Available evidence reports different approaches both to primary FSGS and post-transplant recurrence but optimal therapeutic management has not been established. This retrospective study aimed to analyze in a monocentric cohort of kidney transplanted patients those with primary FSGS to establish the post-transplant recurrence rate of FSGS and its treatment. Patients and Methods. 2816 kidney transplanted patients at Padova University Hospital from 1995 to 2023 were retrospectively evaluated to identify those with pretransplant primary FSGS, establish the recurrence rate of post-transplant FSGS and the adopted treatment. Results. 20 patients out of 2816 had pretransplant primary FSGS and in 5 of them post-transplant recurrences of FSGS were observed (25%). In these patients, immunosuppression regimens with tacrolimus/mycophenolate mofetil/corticosteroids were the most used (75%). Plasmapheresis was used in 4 recurrences and one patient was also treated with rituximab. Conclusions. Optimal management of FSGS recurrence after transplantation is not yet established while evidence regarding the positive effect of current treatment strategies is very little and limited by a very low number of well-designed randomized trials. Although with limitations, our study might be considered as a further contribution to the limited number of available studies on the still open challenge of identifying the most effective management to reduce/prevent post-transplant FSGS recurrence and provide its best treatment.