Abstract: SA-OR82
Favorable Treatment Responses of Recurrent Focal Segmental Glomerulosclerosis in Children after Kidney Transplantation: A Contemporary Multicenter Electronic Health Record Data Analysis
Session Information
- Transplantation: Clinical Management and Monitoring
October 26, 2024 | Location: Room 25, Convention Center
Abstract Time: 04:30 PM - 04:40 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Dharnidharka, Vikas R., Washington University in St Louis, St Louis, Missouri, United States
- Scobell, Rebecca R., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Kallash, Mahmoud, Nationwide Children's Hospital, Columbus, Ohio, United States
- Marchesani, Nicole, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Denburg, Michelle, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
Group or Team Name
- PedsNet GLEAN Investigators.
Background
Recurrence of focal segmental glomerulosclerosis (FSGS) after kidney transplant leads to significant morbidity and potentially earlier allograft loss. To date however, reported rates, risk factors and treatment outcomes have varied widely.
Methods
We applied computational phenotypes to a multicenter aggregation of electronic health records data from 7 large pediatric health systems in the USA, to identify recurrence rates, risk factors and treatment outcomes. We refined the data collection by chart review.
Results
From >7 million patients, we compared children with primary FSGS who received a kidney transplant between 2009-2020 and who either developed recurrence (n =67/165; 40.6%) or did not (n = 98/165). 64/67 had recurrence in the first week (Figure 1, panel A). Serum albumin level at time of transplant was significantly lower and recipient HLA DR7 presence was significantly higher in the recurrence group. By 36 months post-transplant, complete remission occurred in 58.2% and partial remission in 17.9% (panel B). Through 6 years post-transplant, no remission after recurrence associated with an increased risk of allograft loss over time (p<0.0001), but any remission showed similar allograft survival (panel C) and function decline (panel D) to those with no recurrence. Since treatments were used in non-random fashion, using spline curves and multivariable non-linear analyses, complete + partial remission chance was significantly higher with greater plasmapheresis sessions, CTLA4-Ig doses or LDL-apheresis sessions. Only treatment with anti-CD20, CTLA4-Ig agents or LDL-apheresis sessions were associated with complete remission (panel E). Excluding 25 patients with mutations raised the recurrence rate to a range between 45-47.14% but did not significantly change other results.
Conclusion
Our contemporary high-risk cohort had higher favorable response rates than most prior reports, from combinations of agents.
Figure 1
Funding
- Other U.S. Government Support