RECURRENCE RATE POST RENAL TRANSPLANT OF CHILDHOOD NEPHROTIC - - PowerPoint PPT Presentation

RECURRENCE RATE POST RENAL TRANSPLANT OF CHILDHOOD NEPHROTIC SYNDROME, AT RED CROSS CHILDREN’S HOSPITAL

Jonathan Buckley, Priya Gajjar, Peter Nourse Red Cross War Memorial Children’s Hopital

Introduction

• Nephrotic syndrome (NS) is recognized cause of ESRD
• The definitive treatment option in ESRD is renal

transplantation

• But many types of NS reoccur in the graft kidney
• FSGS especially has a recurrence of 20-40%1
• Internationally, certain predisposing factors have been

identified2

• Little has been published on the characteristics and

recurrence of NS in an African setting

(1Tejani et al, 1992)

(2Ponticelli et al, 2010)

Aim

• To describe the characteristics of the patients

with NS who were transplanted at Red Cross Children’s Hospital

• To determine the recurrence rate of NS in the

graft kidney post renal transplant

Methods

• This was a retrospective descriptive study
• The medical records of all patients with

nephrotic syndrome, who received a renal transplant at Red Cross Children’s Hospital from 1996 to 2012, were reviewed

Results

• 148 renal transplants at RXH from 1996-2012
• Average of 9.25 transplants per year
• 28 (18.7%) had NS
• Only 19 complete records could be found

Characteristics

• Mean age at presentation with NS: 5yrs

(Range 1-14yrs)

• Mean age at transplant: 10yrs

(Range 3-15yrs)

• Male to female ratio 11:8
• 47% were Black African
• 47% were Mixed Race
• 6% were Caucasian

Histiological subtypes

FSGS MCGN MPGN CN 7 (25%) 16 (57%) 2 (7%) 3 (11%)

Steroid responsiveness

• 5 patients were initially responsive to steroids
• 14 patients were steroid resistant at

presentation

Donor type

• 4 patients received grafts from living related

donors

• 14 patients received grafts from cadaver

donors

• 1 patient received a graft from a living non

related donor

Induction therapy

• 9 patients received induction therapy
• 4 patients did not
• In 5 patients the records were not complete

Time from presentation to ESRF

• Progression to ESRF within 3yrs of

presentation has been shown to be a risk factor for recurrence

• 8 patients developed ESRF within 3 yrs of

presentaion

• 11 patients did not

Outcomes

• 8 patients lost their grafts
• The 1 year graft survival rate was 89%
• The 5 year graft survival rate was 50%
• 5 patients died
• 7 patients have been successfully transitioned

Recurrence rate

5 10 15 20 25 30

7 %

12,5%

Total recurrence rate FSGS recurrence rate

FSGS patients characteristics

• Both presented between 6-15yrs of age (9 and

14yrs respectively)

• Both had induction therapy at transplant
• Neither was Caucasian
• Neither developed ESRD within 3yrs of

presentation

cont.

• In both cases the donors were young (18 and

32yrs)

• The graft kidneys were from deceased donors
• Only one patient had nephrectomies
• One patient had a biopsy showing no

mesangial proliferation

Conclusion

• FSGS was the most common histological type of

NS, leading to renal transplantation

• Our recurrence rate of 12,5%, in our small group
• f FSGS patients, is low
• A possible explanation is that this is a single

center study, and that the spectrum of the NS, we see is different

• Due to the small sample size no statistical

inference could be made with regards to possible predisposing factors

Future suggestions

• National paediatric transplant registry
• Bigger sample size- better data
• Able to calculate national recurrence rate
• Determine what predisposing factors may lead

to reoccurrence

• Therefore offer a better service to our patients

and ensure that valuable resources are use appropriately

Thanks

• SCAH and UCT
• Red Cross Children’s Hospital
• Drs Peter Nourse and Priya Gajjar
• Prof Mignon McColluch
• OUR PATIENTS- WHO TEACH US NEW LESSONS

EVERDAY!

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