Sami Alasfar1, Dany Matar2, Robert A Montgomery3, Niraj Desai4, Bonnie Lonze3, Vikas Vujjini5, Michelle M Estrella6,7, John Manllo Dieck1, Gebran Khneizer8, Sanja Sever7, Jochen Reiser9, Nada Alachkar1. 1. Division of Nephrology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD. 2. McKinsey and Company, Washington, DC. 3. Department of Surgery, New York University, New York, NY. 4. Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD. 5. Department of Medicine, Sinai Hospital, Baltimore, MD. 6. Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA. 7. Division of Nephrology, Massachusetts General Hospital, Charlestown, MA. 8. Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, MO. 9. Department of Medicine, Rush University, Chicago, IL.
Abstract
BACKGROUND: Focal segmental glomerulosclerosis (FSGS) is a common cause of end-stage renal disease with a high rate of recurrence after kidney transplantation. Several factors, such as white race, rapid progression, and previous allograft failure due to recurrence, were found to be risks of recurrence. Data are limited on the benefits of rituximab and/or therapeutic plasma exchange (TPE) in preventing recurrence. In this study, we sought to assess the efficacy of rituximab and TPE for the prevention and treatment of recurrent FSGS after kidney transplantation. METHODS: We enrolled 66 patients with FSGS in this prospective observational study and followed their outcomes. Patients with high risk for recurrence received preventative therapy with TPE and/or rituximab. RESULTS: Twenty-three (62%) of the 37 patients who received preventative therapy developed recurrence compared with 14 (51%) recurrences of the 27 patients who did not receive any therapy (P = 0.21). There was a trend for less relapse when rituximab was used as a therapy for recurrent FSGS (6/22 vs 9/18, P = 0.066). We used a clinical score of 5 values to assess the prediction of FSGS recurrence. A score of 3 or more had a predictive receiver operating characteristic curve of 0.72. Treatment with TPE and/or rituximab resulted in better allograft survival than historical studies. Allograft failure because of recurrent FSGS occurred in only 6 (9%) patients. CONCLUSIONS: Preventative therapies do not decrease the recurrence rate of recurrent FSGS. However, prompt treatment of recurrence with these therapies may result in improved outcomes.
BACKGROUND:Focal segmental glomerulosclerosis (FSGS) is a common cause of end-stage renal disease with a high rate of recurrence after kidney transplantation. Several factors, such as white race, rapid progression, and previous allograft failure due to recurrence, were found to be risks of recurrence. Data are limited on the benefits of rituximab and/or therapeutic plasma exchange (TPE) in preventing recurrence. In this study, we sought to assess the efficacy of rituximab and TPE for the prevention and treatment of recurrent FSGS after kidney transplantation. METHODS: We enrolled 66 patients with FSGS in this prospective observational study and followed their outcomes. Patients with high risk for recurrence received preventative therapy with TPE and/or rituximab. RESULTS: Twenty-three (62%) of the 37 patients who received preventative therapy developed recurrence compared with 14 (51%) recurrences of the 27 patients who did not receive any therapy (P = 0.21). There was a trend for less relapse when rituximab was used as a therapy for recurrent FSGS (6/22 vs 9/18, P = 0.066). We used a clinical score of 5 values to assess the prediction of FSGS recurrence. A score of 3 or more had a predictive receiver operating characteristic curve of 0.72. Treatment with TPE and/or rituximab resulted in better allograft survival than historical studies. Allograft failure because of recurrent FSGS occurred in only 6 (9%) patients. CONCLUSIONS: Preventative therapies do not decrease the recurrence rate of recurrent FSGS. However, prompt treatment of recurrence with these therapies may result in improved outcomes.
Authors: Vincent Audard; Nassim Kamar; Dil Sahali; Isabelle Cardeau-Desangles; Sébastien Homs; Philippe Remy; Jessie Aouizerate; Marie Matignon; Lionel Rostaing; Philippe Lang; Philippe Grimbert Journal: Transpl Int Date: 2012-03-13 Impact factor: 3.782
Authors: S Hariharan; M B Adams; D C Brennan; C L Davis; M R First; C P Johnson; R Ouseph; V R Peddi; C J Pelz; A M Roza; F Vincenti; V George Journal: Transplantation Date: 1999-09-15 Impact factor: 4.939
Authors: George W Burke; Jayanthi Chandar; Junichiro Sageshima; Mariella Ortigosa-Goggins; Pooja Amarapurkar; Alla Mitrofanova; Marissa J Defreitas; Chryso P Katsoufis; Wacharee Seeherunvong; Alexandra Centeno; Javier Pagan; Lumen A Mendez-Castaner; Adela D Mattiazzi; Warren L Kupin; Giselle Guerra; Linda J Chen; Mahmoud Morsi; Jose M G Figueiro; Rodrigo Vianna; Carolyn L Abitbol; David Roth; Alessia Fornoni; Phillip Ruiz; Gaetano Ciancio; Eduardo H Garin Journal: Pediatr Nephrol Date: 2022-05-04 Impact factor: 3.714
Authors: Audrey Uffing; Maria José Pérez-Sáez; Marilda Mazzali; Roberto C Manfro; Andrea Carla Bauer; Frederico de Sottomaior Drumond; Michelle M O'Shaughnessy; Xingxing S Cheng; Kuo-Kai Chin; Carlucci G Ventura; Fabiana Agena; Elias David-Neto; Juliana B Mansur; Gianna Mastroianni Kirsztajn; Helio Tedesco-Silva; Gilberto M V Neto; Carlos Arias-Cabrales; Anna Buxeda; Mathilde Bugnazet; Thomas Jouve; Paolo Malvezzi; Enver Akalin; Omar Alani; Nikhil Agrawal; Gaetano La Manna; Giorgia Comai; Claudia Bini; Saif A Muhsin; Miguel Carlos Riella; Silvia R Hokazono; Samira S Farouk; Meredith Haverly; Suraj Sarvode Mothi; Stefan P Berger; Paolo Cravedi; Leonardo V Riella Journal: Clin J Am Soc Nephrol Date: 2020-01-23 Impact factor: 8.237