Primary focal and segmental glomerulosclerosis (pFSGS) frequently recurs after transplantation and is associated with a poor prognosis. We describe here the successful kidney graft reuse in an adult recipient, eight months after early pFSGS recurrence resistant to all available therapeutics. Patient 1, a 23-year-old man, followed for kidney failure secondary to pFSGS, was first transplanted in 2018 with a deceased donor graft. Unfortunately, we observed an immediate recurrence of biopsy-proven pFSGS. After four lines of treatment (IV cyclosporine + corticosteroids, plasma exchanges, immunoadsorption and rituximab), the patient was still highly nephrotic and kidney function was slowly deteriorating. After approval from both the health authority (Biomedicine Agency) and patient 1, the graft was detransplanted eight months after transplantation and re-implanted in patient 2, a 78-year-old non-immunized and anephric recipient (bi-nephrectomy two years previously for bilateral renal carcinoma). We observed immediate kidney function and progressive resolution of proteinuria (serum creatinine 1.2mg/L, proteinuria 0.1g/24h one year later). Biopsies performed after surgery showed persistent FSGS lesions with a decrease in overall foot process effacement. To our knowledge, this is the first reported case showing that kidney graft transfer may still be a viable option for refractory pFSGS several months after transplantation.
Copyright © 2021. Published by Elsevier Inc.

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