Early use of plasmapheresis for recurrent post-transplant FSGS.
Recurrence of focal segmental glomerulosclerosis (FSGS) in an allograft is a challenging clinical situation because it frequently results in graft loss. We report our experience with early use of plasmapheresis in recurrent FSGS. Of the 18 (33%) children with biopsy-proven FSGS (in their native kidneys) transplanted at our institution, 6 had recurrence (elevated urine protein/creatinine ratios) post transplant and were treated with plasmapheresis. Patients who received treatment within 1 day of the recurrence (4/6) went into remission after 5-13 plasmapheresis treatments, within 5-27 days of starting treatment. Patients who did not respond to plasmapheresis (2/6) were treated 7 and 17 days after onset of proteinuria; 1 of these had acute tubular necrosis and acute rejection leading to graft loss and the other developed acute rejections, ongoing proteinuria, and subsequent graft loss. All 4 patients who went into remission have maintained good graft function, 22-53 months post transplant. In our experience early institution of plasmapheresis for recurrent post-transplant proteinuria in FSGS is effective.
Pradhan
Madhura
M
Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA. pradhan@email.chop.edu
Petro
Julie
J
Palmer
Joanne
J
Meyers
Kevin
K
Baluarte
H Jorge
HJ
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000601:surgery* / Q000628:therapy*; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation; D008297:Male; D010956:Plasmapheresis; D011183:Postoperative Complications / Q000628:therapy; D011507:Proteinuria / Q000628:therapy; D012008:Recurrence