Article Dans Une Revue Nephrology Dialysis Transplantation Année : 2024

Prophylactic treatment of FSGS recurrence in patients who relapsed on a previous kidney graft

1 Service Néphrologie, Hémodialyses [CHU Clermont-Ferrand]
2 CHU Clermont-Ferrand
3 Hôpital Henri Mondor - Service de néphrologie et transplantation
4 Service de Néphrologie-transplantation-dialyse [Bordeaux]
5 Service de néphrologie et hémodialyse [CHU de Strasbourg]
6 Service de néphrologie et immunologie clinique [CHRU Tours]
7 Département de Néphrologie et Transplantation d'organes [CHU Toulouse]
8 Transplantation rénale [CHU Grenoble]
9 Service de néphrologie-transplantation rénale, CHU de Montpellier
10 Néphrologie et Transplantation [CHU Reims]
11 CHU Tenon [AP-HP]
12 Service de Néphrologie [Rouen]
13 Service Néphrologie et transplantation rénale Adultes [CHU Necker]
14 Service de Néphrologie [CHRU Besançon]
15 Service de Néphrologie-Dialyse-Transplantation [CHU Amiens-Picardie]
16 Service de Néphrologie-Hémodialyse-Transplantation rénale [CHU Poitiers]
17 Service de Néphrologie, Dialyse, Transplantations [CHU Limoges]
18 CHU Marseille
19 Hôpital Foch [Suresnes]
20 ITERT - Institut de Transplantation et de Recherche en Transplantation [CHU Nantes]
21 Service de Néphrologie-Dialyse-Transplantation rénale [CHU Caen]
22 Département de Néphrologie - Hôpital Pasteur [Nice]
23 Service de Néphrologie Dialyse, Transplantation rénale [CHU Saint Etienne]
24 Service de Néphrologie-Dialyse-Transplantation [Angers]
25 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
26 CHELTER - Role of intra-Clonal Heterogeneity and Leukemic environment in ThErapy Resistance of chronic leukemias
Valérie Moal
  • Fonction : Auteur
Clément Gosset
  • Fonction : Auteur

Résumé

ABSTRACT Background Recurrence of focal segmental glomerulosclerosis (FSGS) is common after kidney transplantation and is classically associated with a significant decrease in graft survival. A major risk factor is a prior history of FSGS recurrence on a previous graft. This analysis reports the impact of a prophylactic treatment of FSGS recurrence in very high-risk patients who experienced a recurrence on a previous graft. Methods We performed a retrospective multicentre observational study in 25 French transplantation centres. The inclusion criteria were patients aged more than 18 years who had undergone kidney transplant between 31 December 2004 and 31 December 2020, and who had a history of FSGS recurrence on a previous graft. Results We identified 66 patients: 40 received prophylactic treatment (PT+), including intravenous cyclosporine and/or rituximab and/or plasmapheresis, and 26 did not receive any prophylactic treatment (PT–). The time to progression to end-stage kidney disease was similar between groups. The PT+ group was younger at FSGS diagnosis and at the time of kidney retransplantation and lost their previous graft faster. The overall recurrence rate was 72.7% (76.9% in the PT– group and 70.0% in the PT+ group, P = .54). At least partial remission was achieved in 87.5% of patients. The 5-year graft survival was 67.7% [95% confidence interval (CI) 53.4%–78.4%]: 65.1% (95% CI 48.7%–77.4%) in patients with FSGS recurrence vs 77.3% (95% CI 43.8%–92.3%) in patients without recurrence (P = .48). Conclusion Our study suggests that prophylactic treatment should not be used routinely in patients receiving a second transplantation after recurrence of FSGS on a previous graft. The recurrence rate is high regardless of the use of prophylactic treatment. However, the 5-year graft survival remains satisfactory.
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hal-04885610 , version 1 (15-01-2025)

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Charlotte Uro-Coste, Céline Lambert, Vincent Audard, Lionel Couzi, Sophie Caillard, et al.. Prophylactic treatment of FSGS recurrence in patients who relapsed on a previous kidney graft. Nephrology Dialysis Transplantation, 2024, ⟨10.1093/ndt/gfae108⟩. ⟨hal-04885610⟩
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