Successful transplant of a kidney with focal segmental glomerulosclerosis

Abstract

The gap between the number of kidneys available for transplantation and the number of recipients awaiting a kidney is growing. Consequently there is increasing interest in the donation of marginal kidneys [ 1]. Kidneys have been successfully transplanted from donors with known polycystic kidney disease [ 2], diabetic glomerulosclerosis [ 3], and horseshoe kidneys [ 4]. The reuse of a transplanted kidney has also been described [ 5]. Resolution of glomerular disease has been reported after transplantation of organs with diabetic glomerulosclerosis [ 3] and mesangial IgA deposits [ 6]. The presence of nephrotic syndrome in the donor has been considered a contra‐indication to transplantation; even a recent study of transplantation of pairs of ‘extended criteria’ donor kidneys excluded potential donors with greater than 3 g/24 h proteinuria [ 7]. We have been able to identify only one previous report of transplantation of kidneys from donors with nephrotic syndrome, and involving successful transplantation of kidneys from a donor with minimal‐change nephropathy; proteinuria rapidly resolved following transplantation [ 8]. Primary focal segmental glomerulosclerosis (FSGS) is thought to be caused by a circulating factor [ 9] and would therefore be expected to resolve following transplantation. We report successful renal transplantation, with resolution of proteinuria, from a cadaveric donor with FSGS who had nephrotic syndrome for 38 years.