Mohan Shenoy1, Rachel Lennon2,3, Nick Plant2, Dean Wallace2, Amrit Kaur2. 1. Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK. mohan.shenoy@mft.nhs.uk. 2. Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK. 3. Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, England.
Abstract
BACKGROUND: Children with non-genetic steroid-resistant nephrotic syndrome (SRNS) are at high risk of disease recurrence (DR) and graft loss following renal transplant (RT). Although pre-emptive plasma exchange (PE) and rituximab have been suggested to prevent DR, there is insufficient published data to support this practice. The aim is to study the role of pre-emptive PE and rituximab in the prevention of DR in children with non-genetic SRNS undergoing living donor (LD) RT. METHODS: Prospective single-centre study of four consecutive children (age 6-17 years) with non-genetic SRNS (including two with previous graft loss due to DR) who underwent LD RT between July 2014 and September 2016. All patients received a single dose of rituximab 375 mg/m2 2-4 weeks prior to the RT and four sessions of PE in the week prior to RT. All patients had previously undergone bilateral native nephrectomies. RESULTS: All children had early DR (2-26 days) following LD RT. Following early initiation of PE, three children achieved partial remission (PR) or complete remission (CR) 5-22 days after commencing treatment. One child continued to have heavy proteinuria along with graft dysfunction despite 52 sessions of PE and lost the graft 5 months after RT. At the latest follow-up of 36-60 months following RT, one child remains in CR and two are in PR. The latest eGFR was 45-104 ml/min/1.73m2. CONCLUSIONS: Pre-emptive rituximab and PE does not prevent DR in high-risk non-genetic SRNS. Prompt initiation of PE following DR appears to achieve PR or CR in the majority of patients.
BACKGROUND:Children with non-genetic steroid-resistant nephrotic syndrome (SRNS) are at high risk of disease recurrence (DR) and graft loss following renal transplant (RT). Although pre-emptive plasma exchange (PE) and rituximab have been suggested to prevent DR, there is insufficient published data to support this practice. The aim is to study the role of pre-emptive PE and rituximab in the prevention of DR in children with non-genetic SRNS undergoing living donor (LD) RT. METHODS: Prospective single-centre study of four consecutive children (age 6-17 years) with non-genetic SRNS (including two with previous graft loss due to DR) who underwent LD RT between July 2014 and September 2016. All patients received a single dose of rituximab 375 mg/m2 2-4 weeks prior to the RT and four sessions of PE in the week prior to RT. All patients had previously undergone bilateral native nephrectomies. RESULTS: All children had early DR (2-26 days) following LD RT. Following early initiation of PE, three children achieved partial remission (PR) or complete remission (CR) 5-22 days after commencing treatment. One child continued to have heavy proteinuria along with graft dysfunction despite 52 sessions of PE and lost the graft 5 months after RT. At the latest follow-up of 36-60 months following RT, one child remains in CR and two are in PR. The latest eGFR was 45-104 ml/min/1.73m2. CONCLUSIONS: Pre-emptive rituximab and PE does not prevent DR in high-risk non-genetic SRNS. Prompt initiation of PE following DR appears to achieve PR or CR in the majority of patients.
Authors: R Y Gohh; A F Yango; P E Morrissey; A P Monaco; A Gautam; M Sharma; E T McCarthy; V J Savin Journal: Am J Transplant Date: 2005-12 Impact factor: 8.086
Authors: Jonathan H Pelletier; Karan R Kumar; Rachel Engen; Adam Bensimhon; Jennifer D Varner; Michelle N Rheault; Tarak Srivastava; Caroline Straatmann; Cynthia Silva; T Keefe Davis; Scott E Wenderfer; Keisha Gibson; David Selewski; John Barcia; Patricia Weng; Christoph Licht; Natasha Jawa; Mahmoud Kallash; John W Foreman; Delbert R Wigfall; Annabelle N Chua; Eileen Chambers; Christoph P Hornik; Eileen D Brewer; Shashi K Nagaraj; Larry A Greenbaum; Rasheed A Gbadegesin Journal: Pediatr Nephrol Date: 2018-07-07 Impact factor: 3.714
Authors: Agnieszka Bierzynska; Hugh J McCarthy; Katrina Soderquest; Ethan S Sen; Elizabeth Colby; Wen Y Ding; Marwa M Nabhan; Larissa Kerecuk; Shivram Hegde; David Hughes; Stephen Marks; Sally Feather; Caroline Jones; Nicholas J A Webb; Milos Ognjanovic; Martin Christian; Rodney D Gilbert; Manish D Sinha; Graham M Lord; Michael Simpson; Ania B Koziell; Gavin I Welsh; Moin A Saleem Journal: Kidney Int Date: 2017-01-20 Impact factor: 10.612
Authors: Wen Y Ding; Ania Koziell; Hugh J McCarthy; Agnieszka Bierzynska; Murali K Bhagavatula; Jan A Dudley; Carol D Inward; Richard J Coward; Jane Tizard; Christopher Reid; Corinne Antignac; Olivia Boyer; Moin A Saleem Journal: J Am Soc Nephrol Date: 2014-02-07 Impact factor: 10.121