BACKGROUND/AIMS: Recurrent focal segmental glomerulosclerosis (FSGS) following renal transplantation is relatively common. However, the risk factors and optimal pretransplant treatment preventing recurrence of FSGS remain controversial. METHODS: We retrospectively reviewed 27 adult renal transplant recipients with FSGS over a period of 10 years. We first compared possible risk factors for FSGS recurrence between the recurrence and nonrecurrence groups. Then we evaluated the effect of pretransplant plasmapheresis (PP; n = 4) and PP with rituximab (PP + RTX; n = 5) on recurrence of FSGS after transplantation compared to control patients that were not treated with these modalities. RESULTS: There were seven recurrences in 27 patients (25.9%), but there were no significant differences in possible risk factors for FSGS recurrence between the two groups. Recurrence rates between patients with pretransplant PP or PP + RTX and control patients were not significantly different (22.2% vs. 27.7%, p > 0.05). There was also no significant difference in recurrence between the pretransplant PP and PP + RTX groups (25% vs. 20%, p > 0.05). CONCLUSIONS: Pretransplant PP or PP + RTX do not significantly decrease the recurrence of FSGS in adult renal transplant candidates.
Adult ; Antibodies, Monoclonal, Murine-Derived/*administration & dosage ; Female ; Glomerulosclerosis, Focal Segmental/diagnosis/immunology/*surgery ; Humans ; Immunosuppressive Agents/*administration & dosage ; *Kidney Transplantation/adverse effects ; Male ; Middle Aged ; *Plasmapheresis ; Recurrence ; Retrospective Studies ; Risk Factors ; Treatment Outcome

OBJECTIVETo study the effect of FTY720 on glomerulosclerosis and expression of cell cycle regulatory proteins in subtotal nephrectomized rats.

METHODSTwenty-four rats were divided into sham-operation group, glomerulosclerosis model group and FTY720 treated glomerulosclerosis group with 8 rats in each group. The rats in the latter two groups were subjected to subtotal nephrectomy. After operation, the FTY720 treated group was fed with FTY720 at a dose of 0.5 mg/(kg x d) for 12 weeks. Urine protein excretion was measured before operation and 2 w, 4 w, 8 w and 12 w after operation. Then the rats were sacrificed and the left kidney was subjected to pathological evaluation. The expression of collagen IV, fibronectin, and cyclin E, p21, p27 were determined by immunohistochemical methods.

RESULTSCompared with the control group, the model group showed higher daily urine protein (Up) excretion from 2 w, (8.07 +/- 1.61) mg/d and thereafter. At 12 w, Up increased to (28.60 +/- 12.21) mg/d in model group, significantly higher than that in control group (P < 0.05). After treatment with FTY720, Up began to decrease from 4 w after operation, (9.90 +/- 1.49) mg/d at that time and (11.35 +/- 2.09) mg/d at 12 w, both were significantly lower than those in model group (P < 0.01). The model group showed higher level of serum creatinine from 8 w, (61.08 +/- 4.28) micromol/L at that time, (130.20 +/- 23.90) micromol/L at 12 w, both were much higher than those in control group (P < 0.05). In FTY720 treated group, serum creatinine level was (80.19 +/- 7.11) micromol/L at 12 w, much lower than that in model group. The changes of BUN were similar to those of creatinine in each group. Renal pathology and immunohistological evaluation showed that FTY720 could significantly inhibit the expression of collagen-IV and fibronectin in glomeruli and attenuate the extent of glomerulosclerosis. Moreover, FTY720 could upregulate glomerular expression of p21 and downregulate glomerular expression of p27 and cyclin E. The expression levels of p21 and cyclin E were significantly lower in treatment group than in model group (P < 0.05), but still higher than those in control group (P < 0.05). p27 expression in glomeruli was stronger in treatment group than that in model group (P < 0.05), and lower than that in normal group but the difference was not significant.

CONCLUSIONFTY720 can diminish urine protein excretion and prevent glomerulosclerosis in subtotally nephrectomized rats. This protective effect is presumed to be associated with its effect on expression of cell cycle regulatory proteins, and inhibition of extracellular matrix accumulation in glomeruli.

Animals ; Cell Cycle Proteins ; biosynthesis ; Disease Models, Animal ; Fingolimod Hydrochloride ; Glomerulosclerosis, Focal Segmental ; metabolism ; pathology ; therapy ; Immunosuppressive Agents ; pharmacology ; therapeutic use ; Kidney ; pathology ; surgery ; Male ; Nephrectomy ; adverse effects ; Postoperative Period ; Propylene Glycols ; pharmacology ; therapeutic use ; Rats ; Rats, Sprague-Dawley ; Sphingosine ; analogs & derivatives ; pharmacology ; therapeutic use

Focal segmental glomerulosclerosis (FSGS) is an important cause of nephrotic syndrome and end-stage renal disease. FSGS recurrence after renal transplantation has a potentially detrimental course leading to the loss of renal function. In order to establish FSGS recurrence rates and evaluate the course of the disease on living-related-donor renal transplantation in ethnic Korean adults (> or = 18 years), we reviewed our experiences of 27 kidney transplantations with FSGS over the last 15 years. Of the 27 renal allografts, 13 were found to have recurrent FSGS by graft biopsy. In comparison with background data upon patients with and without recurrence of FSGS, the donor age of patients with recurrent FSGS was significantly higher than that of those without recurrence (median, 39 years vs 26, p < 0.05). In terms of, age at transplantation, length of dialysis period, and mode of dialysis no differences were found between recurrent and nonrecurrent cases. The graft survival rate of recipients from a kidney donor of age less than 40 years was significantly higher than that of recipients from a kidney donor of age more than 40 years, at 5 and 10 years, respectively (87% vs 33%, 41% vs 0%, p < 0.05). The association between clinical variables and recurrence was assessed by multiple logistic regression analysis, and donor age was found to be a risk factor of FSGS recurrence (p <0.05). Variables such as HLA-mismatch numbers and immunosuppression were not found to be associated. In conclusion, the recurrence rate of FSGS in adult recipients with FSGS was 48% and patients that received kidney from an older donor appear to be at higher risk of developing recurrence. The use of a renal graft from a younger donor is considered advisable for adult recipients with FSGS.
Adult ; Female ; Follow-Up Studies ; Glomerulosclerosis, Focal/surgery* ; Human ; Kidney Transplantation* ; Male ; Middle Age ; Prognosis ; Recurrence ; Treatment Outcome