Apheresis treatment of recurrent focal segmental glomerulosclerosis after kidney transplantation: re-analysis of published case-reports and case-series.
A systematic re-analysis of published cases was performed to better define the role of plasmapheresis in the treatment recurrent focal segmental glomerulosclerosis after renal transplantation. Forty-four cases were identified, of which 32 responded to apheresis. The median number of treatments to response was 9. There was no difference between responders and nonresponders in the total number of treatments performed. The presence of sclerosis on biopsy predicted treatment failure. Relapse after first successful treatment was reported in 10 cases. The median number of treatments received was less and the time from diagnosis to first treatment was greater for patients who relapsed than for patients in whom relapse was not reported, but the differences were not statistically significant. On the basis of this analysis, we recommend early treatment after diagnosis with a regimen of three daily plasmapheresis treatments followed by 6 treatments on an every other day basis.
Davenport
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RD
Department of Pathology, University of Michigan, University Hospital 2G332/0054, Ann Arbor, MI 48109-0054, USA. rddvnprt@umich.edu
D001706:Biopsy; D001781:Blood Component Removal; D018572:Disease-Free Survival; D005923:Glomerulosclerosis, Focal Segmental / Q000150:complications / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation; D009404:Nephrotic Syndrome / Q000209:etiology; D011183:Postoperative Complications / Q000628:therapy*; D011507:Proteinuria / Q000209:etiology; D012008:Recurrence; D016896:Treatment Outcome