Predictive value of race in post-transplantation recurrence of focal segmental glomerulosclerosis in children

Background. Focal segmental glomerulosclerosis (FSGS) is a leading cause of end-stage renal disease (ESRD) in children, and one of the most difficult to manage because of its high recurrence rate posttransplantation (Tx). Sev eral predictive factors have been associated with disease recurrence (DR) a lthough one in particular, the role of recipient race, has not been adequat ely evaluated. Herein we report our experience with DR in the post-Tx perio d in eight patients. Methods. Records were reviewed for all renal transplants performed at St Ch ristopher's Hospital for Children from 1971 to 1997. Results. Twenty patients received 27 allografts for ESRD due to FSGS. Ten ( 37%) grafts went to African-American (AA) children, and 16 (59%) to those o f Caucasian (C) origin. DR was observed in eight (30%) grafts after Tx. No differences were noted between the patients who developed DR and those who did not, with respect to age at diagnosis or time to ESRD. DR was observed in one (10%) of 10 grafts in AA, compared to seven (41%) of 17 grafts in th e other (O) racial groups (P = 0.19). At last follow-up, the only AA recipi ent with DR has maintained stable renal function, while three (43%) of seve n in O have lost their grafts. Conclusion. In conclusion, in our population post-Tx recurrence of FSGS occ urred more frequently and represented a greater threat to graft survival in O recipients than in those of AA descent. Recipient race should therefore be taken into consideration during pre-Tx counselling of families of childr en with FSGS.