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Focal Segmental Glomerulosclerosis in Children: An Emerging Epidemic and Risk Factors for Disease Recurrence in Transplants

Abraham, Elizabeth C., M.D.
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1320172013

Abstract Details

2011, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
The incidence of focal segmental glomerulosclerosis (FSGS), already the second leading cause of end stage renal disease (ESRD) in children, appears to be increasing. Moreover, post-transplant (Tx) FSGS recurrence (R) is a major problem, and there is concern that kidneys from living related donors (LRDs) are more likely to be affected by R than kidneys from deceased donors (DDs). However, prior studies have not accounted for the potentially confounding influence of race on donor type in recurrence risk. AIMS: (1) To study trends in FSGS leading to pediatric ESRD using a national database. (2) To analyze risk factors for FSGS R in the pediatric Tx recipients on a national scale. METHODS: Data from the United Network for Organ Sharing (UNOS) from 1988-2008 was analyzed for number of Tx for a primary diagnosis of FSGS in Tx recipients <21 years old. Poisson regression was used for trend analysis. Differences in trends were examined by age group, gender, race, and UNOS region. Then, UNOS data was examined in a case-control fashion for R vs. non-R in Txs for recipients ages <21years with FSGS. Multiple logistic regression analysis was used to examine the independent variables of gender, race, HLA matching, UNOS pediatric age groups and donor type (LRD vs. DD). RESULTS: Trend analysis of incident kidney Txs for FSGS over time showed a risk ratio of 1.054, or an increase in cases of 5.4% per year or 294% over 20 years (p<0.0001). Hispanic race was associated with a disproportionate increase over time. There were no significant differences in risk ratio based on UNOS pediatric age group, gender, degree of HLA mismatching or UNOS region. FSGS was reported as the cause of ESRD in 2143 pediatric Txs over 20 years. R was reported in 327 cases (15%) overall and more often in younger age groups (1-5 years: 18%, 6-10 years: 20%, 11-17 years: 15%, 18-20 years: 12%, p<0.01). In univariate analysis, males had insignificantly more Rs than females (16% vs. 14%, p=0.14), but whites had more Rs than African-Americans (19% vs. 13%, p<0.0001), and Rs occurred more often in kidneys from LRDs than DDs (17% vs. 14%, p<0.01). Using multivariate analysis, young age (p<0.005), male gender (p=0.03) and white race (p<0.0005) were identified as significant risk factors for R, while donor type became insignificant. CONCLUSIONS: This study confirms our local suspicion that FSGS as a cause of ESRD for incident pediatric kidney Txs is increasing nationally. It also shows that being male, white and very young is associated with a higher likelihood of post-Tx FSGS R. In contrast, there does not appear to be an increase in R risk in kidneys from LRDs when age, gender and ethnicity are considered, possibly because of the higher frequency of LRD Tx in whites and young children. Acknowledgements: Katarina Linden, UNOS
Paul Succop, PhD (Committee Chair)
Mark Mitsnetes, MD (Committee Member)
Frederic Strife, MD (Committee Member)
12 p.
Surgery
pediatric; kidney; transplant; FSGS; recurrence; glomerulosclerosis

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Citations

  • Abraham, M.D., E. C. (2011). Focal Segmental Glomerulosclerosis in Children: An Emerging Epidemic and Risk Factors for Disease Recurrence in Transplants [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1320172013

    APA Style (7th edition)

  • Abraham, M.D., Elizabeth. Focal Segmental Glomerulosclerosis in Children: An Emerging Epidemic and Risk Factors for Disease Recurrence in Transplants. 2011. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1320172013.

    MLA Style (8th edition)

  • Abraham, M.D., Elizabeth. "Focal Segmental Glomerulosclerosis in Children: An Emerging Epidemic and Risk Factors for Disease Recurrence in Transplants." Master's thesis, University of Cincinnati, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1320172013

    Chicago Manual of Style (17th edition)

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© 2011, all rights reserved.
This open access ETD is published by University of Cincinnati and OhioLINK.