OUTCOMES OF RECURRENT FOCAL SEGMENTAL GLOMERULOSCLEROSIS AFTER RENAL TRANSPLANTATION: A SINGLE-CENTRE OBSERVATIONAL STUDY FROM PAKISTAN
DOI:
https://doi.org/10.52764/jms.26.34.3.6Keywords:
Allograft dysfunction, Focal segmental glomerulosclerosis, Kidney transplantation, Proteinuria, RecurrenceAbstract
Objective:
To determine the frequency of recurrent focal segmental glomerulosclerosis after renal transplantation, identify associated factors, and compare graft-related outcomes across recorded management strategies.
Materials and Methods:
This retrospective, record-based observational study was conducted at the Pakistan Kidney and Liver Institute, Lahore. We reviewed records of recipients transplanted between 22 November 2024 and 31 October 2025 under an Institutional Review Board exemption. We included 100 recipients aged 18 to 60 years with biopsy-proven primary focal segmental glomerulosclerosis, using consecutive sampling. Recurrence was defined by allograft biopsy. Recorded management approaches were plasmapheresis plus rituximab plus renin-angiotensin-aldosterone system blockade, plasmapheresis plus renin-angiotensin-aldosterone system blockade, and renin-angiotensin-aldosterone system blockade alone.
Results:
Recurrent focal segmental glomerulosclerosis was identified in 27/100 recipients (27.0%). The median time from transplantation to recurrence was 42 days. Proteinuria was present in all 27 recurrent cases (100.0%). Hematuria was documented in 3/27 cases (11.1%), and dialysis was required in 7/27 cases (25.9%). Mean recent serum creatinine was 5.07 ± 2.38 mg/dL, and mean urinary protein-to-creatinine ratio was 7.57 ± 2.63 mg/mg. Living-related donor transplantation was more frequent in the recurrent group than in the non-recurrent group (24/27, 88.9% versus 47/73, 64.4%; p=0.039). No statistically significant differences were observed across management groups for creatinine, urinary protein-to-creatinine ratio, dialysis requirement, graft dysfunction, or graft loss.
Conclusion:
Recurrent focal segmental glomerulosclerosis occurred early in more than one-quarter of this cohort. Outcome comparisons across management approaches were descriptive and showed no statistically significant differences.
Keywords: Allograft dysfunction; Focal segmental glomerulosclerosis; Kidney transplantation; Proteinuria; Recurrence
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Copyright (c) 2026 Ujala Imran, Adil Manzoor, Arsalan Sarwar, Momal Zahra, Zunaira Fatima, Sheharyar Baig
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