Recurrent focal segmental glomerulosclerosis following renal transplantation in Korean pediatric patients

The recurrence of focal segmental glomerulosclerosis (FSGS) in transplants is a well-known problem in pediatric renal transplantation (Tx). Recently, the I ace of the recipient was recognized as a major variable associated wi th disease recurrence. In view of this finding, we report on our single-cen ter experience of FSGS recurrence in Korean children, an ethnically homogen eous Far East Asian population. Clinical records and renal biopsy specimens , both native and graft, were reviewed for all pediatric renal Txs (recipie nt age less than or equal to 18 yr) performed at Seoul National University Hospital from 1984 to 1999. Twenty-two children with primary FSGS received 22 allografts for renal replacement. The mean age of disease onset ill thes e patients was 5.9 yr. The grafts were from 12 living-related, six living-u nrelated, and four cadaveric donors, and all recipients were immunosuppress ed with cyclosporin A (CsA)-based regimens. Post-transplant recurrence of F SGS was confirmed in nine patients (41%). Long-term graft survival in recur rent and non-recurrent groups was not significantly different. Risk factor analysis showed that patients with a disease duration shelter than 48 month s (odds ratio 11.7, 95% CI 1.53-89.1) and a glomerulosclerosis percentage o f < 55% by renal biopsy (odds ratio 16.0, 95% CI 1.45-176) were at greater risk of disease recurrence. These results suggest that Korean children are similar to non-African-American youngsters in the USA and Europe with respe ct to post-transplant recurrence of FSGS. The same may be true of other Far Eastern Asian children.