Post-transplant recurrence of steroid resistant nephrotic syndrome in children: the Italian experience

William Morello, Sairaj Puvinathan, Giuseppe Puccio, Gian Marco Ghiggeri, Luca Dello Strologo, Licia Peruzzi, Luisa Murer, Michela Cioni, Isabella Guzzo, Enrico Cocchi, Elisa Benetti, Sara Testa, Luciana Ghio, Gianluca Caridi, Massimo Cardillo, Rosanna Torelli, Giovanni Montini

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Background: Steroid resistant nephrotic syndrome (SRNS) is a frequent cause of end stage renal disease in children and post-transplant disease recurrence is a major cause of graft loss. Methods: We identified all children with SRNS who underwent renal transplantation in Italy, between 2005 and 2017. Data were retrospectively collected for the presence of a causative gene mutation, sex, histology, duration of pre-transplant dialysis, age at onset and transplant, HLA matching, recurrence, therapy for recurrence, and graft survival. Results: 101 patients underwent a first and 22 a second renal transplant. After a median follow-up of 58.5 months, the disease recurred on the first renal transplant in 53.3% of patients with a non-genetic and none with a genetic SRNS. Age at transplant > 9 years and the presence of at least one HLA-AB match were independent risk factors for recurrence. Duration of dialysis was longer in children with relapse, but did not reach statistical significance. Overall, 24% of patients lost the first graft, with recurrence representing the commonest cause. Among 22 patients who underwent a second transplant, 5 suffered of SRNS recurrence. SRNS relapsed in 5/9 (55%) patients with disease recurrence in their first transplant and 2 of them lost the second graft. Conclusions: Absence of a causative mutation represents the major risk factor for post-transplant recurrence in children with SRNS, while transplant can be curative in genetic SRNS. A prolonged time spent on dialysis before transplantation has no protective effect on the risk of relapse and should not be encouraged. Retransplantation represents a second chance after graft loss for recurrence.
Original languageEnglish
JournalJournal of Nephrology
Publication statusPublished - Jan 1 2019


  • Kidney transplant
  • Post-transplant recurrence
  • Steroid-resistant nephrotic syndrome


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