Recurrent FSGS after Transplant

There are many diseases which can recur following renal transplant: examples include IgA Nephropathy (which has a very high rate of recurrence on follow biopsy but is rarely clinically relevant in that it does not cause significant allograft dysfunction) and diabetic nephropathy (which frequently recurs but often takes many years to cause allograft compromise). Probably the most clinically important example of disease recurrence following transplant is in primary focal segmental glomerulosclerosis (FSGS), which manifests as nephrotic-range proteinuria and worsening renal function.

One study in NEJM from 2002 estimated the incidence of graft loss due to recurrence of FSGS at about 12.7%. However, once an individual has disease recurrence in one allograft, the chances of having repeat recurrence in a subsequent allograft are much higher, estimated by some at >75%! This speaks to the presence of some circulating humoral factor, such as a cytokine which has yet to be identified) as the causative agent in primary FSGS. Treatment for FSGS recurrence may include plasmapheresis, IVIG, Rituxan, or steroids.