Outcome of Primary Glomerular Disease in Pediatric Renal Transplantation: A Single-Center Experience

Recurrence of idiopathic focal segmental glomerulosclerosis after kidney transplantation: experience of a Korean tertiary center

FSGS is the second most common cause of idiopathic NS in children. It often progresses to ESRD and commonly recurs after KT. To investigate the risk factors and the prognosis of recurrence in pediatric idiopathic FSGS in Korea, retrospective review of 43 KT in 38 children with idiopathic FSGS of last two decades was conducted. The patients presented at the median age of 5.1 yr (range 1.1-13.8 yr) and received KT 5.7 yr later (range 1.3-17.6 yr). FSGS recurred in 20 allografts immediately after transplantation, only in those who presented with NS but not in those who presented with AUA. The risk factors for recurrence were age of onset >5 yr and progression to ESRD within six yr but not sooner than 18 months. CR was achieved in 13 patients with FSGS recurrence and sustained in nine without subsequent relapse over a median of six and a half yr (0.6-20.7 yr). Pediatric idiopathic FSGS presenting with NS recurred in more than half of patients after transplantation. Interestingly, more rapid progression within less than 18 months did not predict recurrence. To identify high-risk patients of recurrence, an international cooperative study would be necessary.

Follow-up of patients with juvenile nephronophthisis after renal transplantation: a single center experience

BACKGROUND

Nephronophthisis (NPHP) is the most common genetic cause of end-stage renal disease (ESRD) in the first 3 decades of life. Treatment of patients with NPHP is symptomatic; kidney transplantation is the treatment of choice when ESRD is established. We report herein our center's experience with kidney transplantation for children with juvenile NPHP.

PATIENTS

We retrospectively analyzed medical records of 9 renal transplant recipients with a primary diagnosis of juvenile NPHP confirmed by genetic analysis and/or renal biopsy findings in a single center from 1996 to 2010.

RESULTS

Of the 9 patients, 6 received a living related and 3 a cadaveric donor transplantation. Preemptive renal transplantation was performed in 7 patients. The median age of the patients was 13.38 ± 4.6 years; the median follow-up period was 17 months. Posttransplantation immusuppression comprised corticosteroids, a calcineurin inhibitor, and mycophenolate mofetil or azathioprine. One patient lost his renal graft owing to renal graft thrombosis, and grade II chronic allograft nephropathy was diagnosed by renal biopsy on the 62th day after renal transplantation in another patient. The median glomerular filtration rates after transplantation at 1, 3, and 5 years were 85, 75.2, and 83.2 mL/min/1.73 m(2), respectively.

CONCLUSION

We observed preserved graft functions for long periods among renal transplant recipients with juvenile NPHP. Chronic allograft nephropathy developed rarely on long follow-up.