Disease Recurrence-The Sword of Damocles in Kidney Transplantation for Primary Focal Segmental Glomerulosclerosis

Frontiers in Immunology
Katrin Kienzl-WagnerStefan Schneeberger

Abstract

A major obstacle in kidney transplantation for primary focal segmental glomerulosclerosis (FSGS) is the risk of disease recurrence. Recurrent FSGS affects up to 60% of first kidney grafts and exceeds 80% in patients who have lost their first graft due to recurrent FSGS. Clinical and experimental evidence support the hypothesis that a circulating permeability factor is the mediator in the pathogenesis of primary and recurrent disease. Despite all efforts, the causing agent has not yet been identified. Several treatment options for the management of recurrent FSGS have been proposed. In addition to plasma exchange, B-cell depleting antibodies are effective in recurrent FSGS. This indicates, that the secretion and/or activity of the postulated circulating permeability factor(s) may be B-cell related. This review summarizes the current knowledge on permeability factor(s) possibly related to the disease and discusses strategies for the management of recurrent FSGS. These include profound B-cell depletion prior to transplantation, as well as the salvage of an allograft affected by recurrent FSGS by transfer into a second recipient.

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Citations

Feb 23, 2020·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Gabriel MorinGuillaume Canaud
Sep 20, 2020·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Catherine JosephPoyyapakkam R Srivaths
Aug 23, 2020·International Journal of Molecular Sciences·Barbara InfanteGiovanni Stallone
Oct 28, 2019·Nature Reviews. Nephrology·Moin A Saleem
Feb 5, 2021·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Hideki BanMotoshi Hattori
Jun 13, 2021·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Aghilès HamrounFrançois Provôt
Jul 22, 2021·Research and Reports in Urology·Josef MangFrank Friedersdorff

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Methods Mentioned

BETA
biopsies
electron microscopy
biopsy

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