The differential effect of race among pediatric kidney transplant recipients with focal segmental glomerulosclerosis

Background: Given the differential effect of race on focal segmental glomerulosclerosis (FSGS) progression in native kidneys, recurrence of FSGS in the transplanted kidney, and allograft source, the authors conducted this study to evaluate the influence of FSGS by race and allograft source. Methods: Data from 8,065 pediatric renal transplant recipients (n=620 FSGS) between 1987 and 1997 from the United Network for Organ Sharing registry were used for this study. Stratified analysis by race and allograft source allowed independent assessment of the effect of FSGS on transplant survival. Results: Among black children, allograft survival was not different between FSGS and non-FSGS patients adjusted for recipient age, recurrent disease, allograft source, zero antigen mismatch, and acute rejection (hazard ratio [HR], 1.15; 95% confidence interval [95% CI], 0.93 to 1.42; P=0.22). Among nonblack children, the risk of allograft failure in children with FSGS was 1.31 times higher than other causes of end-stage renal disease (ESRD) in multivariate analysis (95% CI, 1.04 to 1.64; P=0.02). Despite the impact of disease recurrence in the nonblack children with FSGS, the risk of graft failure was less for living donor recipients (HR, 1.51; 95% CI, 1.08 to 2.10) than for cadaveric recipients (HR, 1.80; 95% CI, 1.32 to 2.44) compared with the lowest risk group (nonblack, non-FSGS, living donor). Conclusion: The effect of FSGS on renal allograft survival in children differs between racial groups. Children of nonblack races with FSGS have a worse allograft survival rate compared with other causes of ESRD. Within nonblack children with FSGS, living donor transplants convey a better allograft survival than cadaveric transplants.