Graft loss due to recurrent focal segmental glomerulosclerosis in renal transplant recipients in the United States

Rates of and risk factors for graft loss and graft loss resulting from recu rrent focal segmental glomerulosclerosis (FSGS) have not been studied in a national population. A retrospective analysis was performed on a national r egistry (1999 United States Renal Data System) of 101,808 renal transplant recipients (October 1, 1987, to December 31, 1996). Of these, 3,861 recipie nts of solitary renal transplants who had end-stage renal disease resulting from FSGS met inclusion criteria. Outcomes were graft loss and graft loss resulting from recurrent FSGS. As a percentage of all graft loss, recurrent FSGS accounted for 18.7% in living donor recipients and 7.8% in cadaveric recipients. In white recipients, the corresponding figures were 27% and 13% . In multivariate analysis, factors associated with graft loss resulting fr om recurrent FSGS were white recipient, donor African-American kidney in wh ite recipient, younger recipient age, and treatment for rejection. African- American recipients had higher rates of graft loss overall. A living donor was associated with superior overall graft survival. Among renal transplant recipients with FSGS, white recipients had a higher risk of graft loss res ulting from recurrent FSGS, disproportionately seen in recipients of Africa n-American kidneys. The role of donor/recipient race pairing on graft loss resulting from recurrent FSGS should be validated. Living donor had no asso ciation with graft loss from recurrent FSGS after correction for other fact ors. African-American recipients with FSGS may have the most to gain from a living donor, given their improved graft survival and decreased risk of gr aft loss resulting from recurrent FSGS.