Single-center analysis of early recurrence of nephrotic syndrome followingrenal transplantation in children

Recurrence of nephrotic syndrome (NS) after transplantation (Tx) occurs in 20 50% of renal transplant recipients, with a median time to recurrence of 14 days and a 50% rate of graft loss. We performed a retrospective analysis of 22 pediatric patients with NS who received renal transplants at the Chi ldren's Hospital, Boston, between 1982 and 1999. During the first 14 days f ollowing Tx, 13 (59%) patients developed clinical recurrent nephrotic syndr ome (RNS). RNS developed in 50% of living donor recipients and in 70% of ca daveric donor recipients (p = non-significant). Seven or the 13 patients wi th RNS were treated with plasmapheresis, while six received standard immuno suppressive induction therapy only. Two of the seven treated patients and o ne of the six untreated patients lost their grafts to RNS, yielding a total RNS graft loss rate of 23%. However, patients with RNS who achieved remiss ion had significantly higher cumulative graft Survival at 5 yr than did RNS patients who did not achieve remission (p < 0.001). Overall cumulative gra ft survival at 5 yr was not significantly different between the two groups: 67% in those with non-recurrent nephrotic syndrome (NRNS) vs. 64% in those with RNS, p = non-significant. We conclude that successful reversal of ear ly RNS improves long-term graft survival in pediatric RNS. Multi-center stu dies are sorely needed to develop novel, less toxic therapies for native an d recurrent NS.