Focal segmental glomerulosclerosis: prevalence, risk factors, and outcome among kidney transplant recipients: Kuwait experience

Authors

Gheith, Osama A.; Zakaria, Zakaryia E.; Fayyad, Zoheer A.; et al.

Citation

Arab J Nephrol Transplant. 2026;8(1):39–46.

Abstract

Background: Posttransplant focal segmental glomerulosclerosis (FSGS) is a major risk factor for graft loss. We therefore aimed to assess patients with FSGS in our cohort of kidney transplant recipients (KTR). Methods: In this retrospective study, kidney transplant recipients (KTR) between 1996 and 2020 were screened for the diagnosis of FSGS, and details were recorded about the transplant, clinical outcomes, treatments, and other risk factors. Results: Among 3221 KTR screened, 109 (3.38%) were identified to have FSGS as original kidney disease. Of them, 57 (52.3%) had a diagnosis of idiopathic FSGS. Most of patients were Kuwaiti males who received their grafts from living donors (82.5 vs. 92.3% in the secondary group). All patients were maintained on calcineurin inhibitors and more than 40% were on angiotensin-receptor blockers or angiotensin-converting enzyme inhibitors without significant difference between the recurrent or nonrecurrent groups (P > 0.05). FSGS recurred in 10 patients (17.5%) which was significantly associating sensitization against tuberculosis. Most patients with recurrent FSGS received plasma exchange (70 vs. 36.2%, P = 0.049) and rituximab (70 vs. 23.4%, P = 0.004) compared to the group without recurrence, respectively. Follow up laboratory parameters showed significantly higher mean serum creatinine after 6 months onwards (P < 0.05), significantly higher proteinuria after 3 months onwards (P < 0.05) and significantly lower mean plasma albumin at third and 12 th months of follow up (P < 0.05). However, the graft outcome was comparable in the two groups (P > 0.05). Conclusions: Lower rate of recurrence of idiopathic FSGS in our cohort (17.5%) and the comparable patient and graft outcomes might be due to the optimized immunosuppressive regimen. The key novel finding is the significant association between sensitization against tuberculosis and the recurrence of primary FSGS, suggesting a potential role of a pre-existing immune-sensitized state that will need further evaluation on a larger scale.

Read More in AJNT

The Arab Journal of Nephrology and Transplantation is the peer-reviewed open-access journal of ASNRT, published since 2008.

Issue table of contents — Vol 8, Issue 1 · AJNT archive · Download full-text PDF (open access)