Unusual post-transplantation recurrence of focal segmental glomerulosclerosis which resolved with cyclosporine but not with sirolimus

Recurrence of idiopathic focal segmental glomerulosclerosis (FSGS) is frequent after the first kidney transplantation (KT), but a recurrence that only occurred after the second KT has never been reported. Although cyclosporine reduces proteinuria and prolongs graft survival in patients with recurrent glomerulosclerosis, the effectiveness of sirolimus for this condition is still not known. We report, for the first time as far as we know, the case of a 35-year-old black male patient who experienced a recurrence of FSGS, 10 days after a second KT, although no recurrence had occurred after the first. Cyclosporine treatment led to a decrease in proteinuria, whereas mycophencilate mofetil and angio tensin-converting enzyme inhibitor had no effect. Cyclosporine was replaced by sirolimus as treatment for chronic allograft nephropathy 24 months after KT. Nephrotic syndrome, which reappeared 3 weeks after the switch, was cured by cyclosporine re-introduction. The absence of FSGS recurrence after the first graft does not totally preclude its recurrence after the second. This observation points to the effectiveness of cyclosporine for the recurrence of FSGS and indicates that sirolimus should be given with caution in such cases.