Incidence and risk factors for recurrent focal segmental glomerulosclerosis after kidney transplantation: a meta-analysis

Figures & data

Figure 1. The process of the identification and inclusion of selected studies.

Table 1. Characteristics and Newcastle–Ottawa Scale quality score of included studies.

Ref no	Author	Year	Study type	NOS	Country	Recurrent FSGS (n)	Sample (n)	Period	Risk factors
1	Baskin [38]	2022	Case-control study	7	Turkey	5	34	2004–2019	Sex, Age at transplantation, Time from diagnosis to kidney failure, Duration of dialysis before KT, Living donor
2	Vallianou [35]	2021	Case-control study	7	Greece	26	46	1993–2019	Sex, Age at transplantation, Age at onset, Time from diagnosis to kidney failure, Living donor, HLA mismatches, Previous transplantation
3	Uffing [37]	2020	Case-control study	9	Unite States	57	176	2005–2015	Sex, Age at transplantation, Time from diagnosis to kidney failure, Duration of dialysis before KT, Previous transplantation, Nephrectomy of native kidneys, Living donor, Related donor, HLA mismatches, Tacrolimus use
4	Puig-Gay [17]	2019	Case-control study	8	Spain	15	37	2013–2015	Sex, Age at transplantation
5	Harel [18]	2019	Case-control study	7	Unite States	18	55	NA	Age at transplantation
6	Alasfar [19]	2018	Case-control study	7	Unite States	37	64	2008–2015	NA
7	Cormica [20]	2018	Case-control study	9	Irish	23	38	1982–2015	Sex, Age at transplantation, Time from diagnosis to kidney failure, Proteinuria before KT, Duration of dialysis before KT, Living donor, Tacrolimus use, HLA mismatches
8	Mujtaba [21]	2015	Case-control study	8	Unite states	12	28	NA	Sex, Age at transplantation, Previous transplantation, Living donor
9	Park [22]	2014	Case-control study	8	Korea	7	27	2000–2010	Sex, Age at transplantation, Time from diagnosis to kidney failure, Proteinuria before KT, Living donor, Related donor, HLA mismatches
10	Straatmann [23]	2014	Case-control study	8	Unite states	7	24	1995–2013	Age at transplantation, Living donor, Related donor, HLA mismatches, Nephrectomy of native kidneys
11	Delville [4]	2014	Case-control study	8	France	27	50	NA	Sex, Age at onset, Previous transplantation, Duration of dialysis before KT
12	Lopez-Hellin [3]	2013	Case-control study	7	Spain	14	74	NA	NA
13	Franco [26]	2013	Case-control study	7	Unite states	13	28	NA	Age at transplantation, Sex, Proteinuria before KT
14	Shishido [27]	2013	Case-control study	8	Japan	10	16	2000–2009	Age at transplantation, Age at onset, Duration of dialysis before KT
15	Maas [28]	2013	Case-control study	9	Netherlands	28	94	1968–2009	Sex, Age at transplantation, Age at onset, Time from diagnosis to kidney failure, Living donor, Related donor, HLA mismatches, Tacrolimus use
16	Sener [33]	2009	Case-control study	8	Canada	5	22	1996–2004	Sex, Age at transplantation, Nephrectomy of native kidneys, Living donor,Proteinuria before KT
17	Hickson [34]	2009	Case-control study	7	Unite States	14	30	2000–2006	Age at transplantation, Sex, Duration of dialysis before KT, Previous transplantation, Related donor, HLA mismatches, Nephrectomy of native kidneys
18	Pardon [36]	2006	Case-control study	8	France	12	35	1986–2001	Sex, Age at onset, Duration of dialysis before KT, Age at transplantation, HLA mismatches
19	Fujisawa [32]	2002	Case-control study	7	Japan	8	13	NA	Sex, Age at onset, Duration of dialysis before KT, HLA mismatches, Nephrectomy of native kidneys
20	Kim [31]	2001	Case-control study	7	Korea	9	22	1984–1999	Sex, Age at onset, Proteinuria before KT, Duration of dialysis before KT, Related donor, Living donor, HLA mismatches
21	Ingulli [29]	1991	Case-control study	8	Unite states	6	28	1974–1990	Previous transplantation
22	Pinto [30]	1981	Case-control study	8	UK	5	25	1967–1979	Age at onset

NA: not available; NOS: Newcastle–Ottawa Scale.

Table 2. Summary of meta-analysis results of risk factors for recurrent focal segmental glomerulosclerosis after renal transplantation.

Factors	No. study	Sample (n)	Heterogeneity test		OR/SMD (95% CI)	p-value	Egger’s test
			p	I^2			t	P
Age at transplantation	16	703	.003	56.7%	−0.47 (−0.73 to −0.20)	.001	−3.40	.004
Age at onset	9	331	.095	40.9%	−0.31(−0.54 to −0.08)	.008	1.60	.153
Time from diagnosis to kidney failure	9	486	.082	42.9%	−0.24 (−0.43 to −0.04)	.018	−2.11	.073
HLA mismatches	7	435	.194	30.6%	−0.17 (−0.37 to 0.04)	.107	−0.14	.898
Proteinuria before KT	6	167	<.001	87.3%	2.04 (0.91 − 3.17)	<.001	2.56	.063
Duration of dialysis before KT	10	441	.174	29.5%	−0.02 (−0.22 to 0.18)	.861	−0.32	.755
Sex	16	704	.262	16.7%	0.78 (0.56–1.07)	.127	−1.52	.150
Living donor	8	467	.546	0.00%	0.88 (0.57 − 1.38)	0.586	−1.10	.312
Related donor	6	373	.203	31.00%	1.99 (1.20 − 3.30)	.007	0.45	.673
Tacrolimus use	3	308	.514	0.00%	0.97 (0.54 − 1.72)	.911	−1.14	.458
Previous transplantation	5	328	.248	26.00%	1.16 (0.68 − 1.97)	.582	0.68	.548
Nephrectomy of native kidneys	3	230	.727	0.00%	6.53 (2.68 − 15.92)	<.001	10.24	.062

Figure 2. The recurrence rate of FSGS by subgroup analysis of the country.

Figure 3. SMD and the corresponding 95% CI for risk factors of recurrent FSGS. Young age at transplantation and age at onset, a short time from diagnosis to kidney failure, and high level of proteinuria before kidney transplantation were associated with recurrent FSGS after kidney transplantation, whereas HLA mismatches and duration of dialysis before kidney transplantation were not associated with recurrent FSGS.

Figure 4. (A) Sensitivity analysis for age at transplantation in the meta-analysis. (B) Trim and filling for age at transplantation in the meta-analysis.

Figure 5. OR and the corresponding 95% CI for risk factors of recurrent FSGS. Related donor and nephrectomy of native kidneys were associated with recurrent FSGS after kidney transplantation, whereas sex, living donor, tacrolimus use, and previous transplantation were not associated with recurrent FSGS.

Figure 6. Funnel chart results of recurrence rate.

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