Lise Allard1, Theresa Kwon2, Saoussen Krid3, Justine Bacchetta4, Arnaud Garnier5, Robert Novo6, Georges Deschenes2, Rémi Salomon3, Gwenaëlle Roussey7, Emma Allain-Launay7. 1. CHU d'Angers, Pôle Femme-Mère-Enfant, Service de Pédiatrie, Angers, France. 2. Hôpital Robert Debré, Service de Néphrologie et Hémodialyse Pédiatrique, Paris, France. 3. Hôpital Necker Enfants Malades, Service de Néphrologie Pédiatrique, Paris, France. 4. Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques, Lyon, France. 5. Hôpitaux de Toulouse, Hôpital des Enfants, Service de Néphrologie, Médecine Interne et Hypertension, Toulouse, France. 6. CHRU Lille, Hôpital Jeanne de Flandre, Service de Néphrologie Pédiatrique, Lille, France. 7. CHU Nantes, Hôpital Mère-Enfants, Néphrologie et Hémodialyse Pédiatrique, Nantes, France.
Abstract
Background: Primary focal segmental glomerulosclerosis (FSGS) frequently recurs after kidney transplantation (KTx) in children. This can lead to delayed graft loss. As the management of children with recurrent FSGS is not well established, apheresis strategies could be a cornerstone to control the disease. Immunoadsorption (IA) is a recent apheresis therapy. There have been few studies examining IA in this setting. We report the results of IA for management of recurrent FSGS after KTx in children in France. Methods: We included all children treated with IA for early FSGS recurrence after KTx between January 2011 and June 2014 in France. We excluded genetic forms of FSGS. Patients' characteristics and technical data on IA were retrospectively collected. Recurrence was defined as nephrotic proteinuria during the post-transplantation period. Partial and complete remissions were defined when urine protein:creatinine ratios were less than 0.2 and 0.05 g/mmol, respectively. Results: Twelve patients, from six paediatric KTx units, presenting with FSGS recurrence between 0 and 21 days after KTx were treated with IA. Ten of 12 children were responders: 2 achieved partial remission and 8 complete remission. The decrease of proteinuria rapidly occurred within the first 10 sessions after initiating IA. After 3 months of IA, two patients maintained remission without IA and eight became IA dependent. No severe side effects were reported. Conclusions: Our study reports on the efficacy of IA in the recurrence of FSGS after KTx in children. Further prospective controlled studies are required to confirm these results and to optimize the management of FSGS recurrence after paediatric KTx.
Background: Primary focal segmental glomerulosclerosis (FSGS) frequently recurs after kidney transplantation (KTx) in children. This can lead to delayed graft loss. As the management of children with recurrent FSGS is not well established, apheresis strategies could be a cornerstone to control the disease. Immunoadsorption (IA) is a recent apheresis therapy. There have been few studies examining IA in this setting. We report the results of IA for management of recurrent FSGS after KTx in children in France. Methods: We included all children treated with IA for early FSGS recurrence after KTx between January 2011 and June 2014 in France. We excluded genetic forms of FSGS. Patients' characteristics and technical data on IA were retrospectively collected. Recurrence was defined as nephrotic proteinuria during the post-transplantation period. Partial and complete remissions were defined when urine protein:creatinine ratios were less than 0.2 and 0.05 g/mmol, respectively. Results: Twelve patients, from six paediatric KTx units, presenting with FSGS recurrence between 0 and 21 days after KTx were treated with IA. Ten of 12 children were responders: 2 achieved partial remission and 8 complete remission. The decrease of proteinuria rapidly occurred within the first 10 sessions after initiating IA. After 3 months of IA, two patients maintained remission without IA and eight became IA dependent. No severe side effects were reported. Conclusions: Our study reports on the efficacy of IA in the recurrence of FSGS after KTx in children. Further prospective controlled studies are required to confirm these results and to optimize the management of FSGS recurrence after paediatric KTx.
Authors: An S De Vriese; Sanjeev Sethi; Karl A Nath; Richard J Glassock; Fernando C Fervenza Journal: J Am Soc Nephrol Date: 2018-01-10 Impact factor: 10.121
Authors: Hamza Naciri Bennani; Lionel Elimby; Florian Terrec; Paolo Malvezzi; Johan Noble; Thomas Jouve; Lionel Rostaing Journal: J Clin Med Date: 2021-12-24 Impact factor: 4.241