Post-transplant recurrence of steroid resistant nephrotic syndrome in children: the Italian experience
Articolo
Data di Pubblicazione:
2020
Citazione:
Post-transplant recurrence of steroid resistant nephrotic syndrome in children: the Italian experience / W. Morello, S. Puvinathan, G. Puccio, G.M. Ghiggeri, L. Dello Strologo, L. Peruzzi, L. Murer, M. Cioni, I. Guzzo, E. Cocchi, E. Benetti, S. Testa, L. Ghio, G. Caridi, M. Cardillo, R. Torelli, G. Montini. - In: JN. JOURNAL OF NEPHROLOGY. - ISSN 1121-8428. - 33:4(2020 Aug 01), pp. 849-857.
Abstract:
Background: Steroid resistant nephrotic syndrome (SRNS) is a frequent cause of end stage renal disease in children and post-transplant disease recurrence is a major cause of graft loss. Methods: We identified all children with SRNS who underwent renal transplantation in Italy, between 2005 and 2017. Data were retrospectively collected for the presence of a causative gene mutation, sex, histology, duration of pre-transplant dialysis, age at onset and transplant, HLA matching, recurrence, therapy for recurrence, and graft survival. Results: 101 patients underwent a first and 22 a second renal transplant. After a median follow-up of 58.5 months, the disease recurred on the first renal transplant in 53.3% of patients with a non-genetic and none with a genetic SRNS. Age at transplant > 9 years and the presence of at least one HLA-AB match were independent risk factors for recurrence. Duration of dialysis was longer in children with relapse, but did not reach statistical significance. Overall, 24% of patients lost the first graft, with recurrence representing the commonest cause. Among 22 patients who underwent a second transplant, 5 suffered of SRNS recurrence. SRNS relapsed in 5/9 (55%) patients with disease recurrence in their first transplant and 2 of them lost the second graft. Conclusions: Absence of a causative mutation represents the major risk factor for post-transplant recurrence in children with SRNS, while transplant can be curative in genetic SRNS. A prolonged time spent on dialysis before transplantation has no protective effect on the risk of relapse and should not be encouraged. Retransplantation represents a second chance after graft loss for recurrence.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Kidney transplant; Post-transplant recurrence; Steroid-resistant nephrotic syndrome
Elenco autori:
W. Morello, S. Puvinathan, G. Puccio, G.M. Ghiggeri, L. Dello Strologo, L. Peruzzi, L. Murer, M. Cioni, I. Guzzo, E. Cocchi, E. Benetti, S. Testa, L. Ghio, G. Caridi, M. Cardillo, R. Torelli, G. Montini
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