Abstract: Ｏｂｊｅｃｔｉｖｅ：To explore the clinicopathological features and allograft outcomes of posttransplant focal segmental glomerulosclerosis (FSGS).
Ｍｅｔｈｏｄｏｌｏｇｙ：Patients with kidney allograft biopsyproven FSGS from January 2013 to December 2019 were studied retrospectively and divided into nephroticrange proteinuria (NP) group and nonnephroticrange proteinuria (nNP) group for comparative analysis.
Ｒｅｓｕｌｔｓ：Fiftytwo patients were enrolled (19 cases in NP group and 33 cases in nNP group).Fortyseven (904％) were male.The median time from transplantation to allograft biopsy was 124 months.The median serum creatinine and proteinuria were 2033 μmol／L and 25 g／24h.The not otherwise specified (NOS),collapsing,cellular,tip and perihilar variant type of FSGS accounted for 692％,115％,77％,77％ and 38％,respectively.Podocyte hyperplasia was found in 29 (558％) patients,and pseudocrescents were present in 7 (135％) patients.Diffuse foot process effacement (FPE) was observed in 18 of 32 (563％) patients.The NP group was diagnosed earlier after transplantation and had higher incidence of edema and infection at biopsy,and more severe degree of tubulointerstitial lesions and FPE than the nNP group (all P<005).Clinical followup was available for 41 patients with a median time of 169 months,and 17 (415％) developed allograft failure.Kidney allograft survival rates were significantly lower in the NP group than in the nNP group (P=0040).Partial or complete remission rates were 600％,500％ and 364％ in plasma exchange and rituximab (PE+RTX) group,RTX group and nonPE／RTX group,respectively.
Ｃｏｎｃｌｕｓｉｏｎ：
Patients with posttransplant FSGS mainly presented with moderate proteinuria and allograft dysfunction;those with early onset after transplantation had more proteinuria,more severe foot process effacement and worse allograft survival.