Preemptive plasmapheresis and recurrence of FSGS in high-risk renal transplant recipients.
Recurrent focal segmental glomerulosclerosis (FSGS) following transplantation is ascribed to the presence of a circulating FSGS permeability factor (FSPF). Plasmapheresis (PP) can induce remission of proteinuria in recurrent FSGS. This study addressed the efficacy of pre-transplant PP in decreasing the incidence of recurrence in high-risk patients. Ten patients at high-risk for FSGS recurrence because of rapid progression to renal failure (n = 4) or prior transplant recurrence of FSGS (n = 6) underwent a course of 8 PP treatments in the peri-operative period. Recurrences were identified by proteinuria >3 g/day and confirmed by biopsy. Seven patients, including all 4 with first grafts and 3 of 6 with prior recurrence, were free of recurrence at follow-up (238-1258 days). Final serum creatinine in 8 patients with functioning kidneys averaged 1.53 mg/dL. FSGS recurred within 3 months in 3 patients, each of whom had lost prior transplants to recurrent FSGS. Two of these progressed to end-stage renal disease (ESRD) and the third has significant renal dysfunction. Based on inclusion criteria, recurrence rates of 60% were expected if no treatment was given. Therefore, PP may decrease the incidence of recurrent FSGS in high-risk patients. Definitive conclusions regarding optimal management can only be drawn from larger, randomized, controlled studies.
Gohh
R Y
RY
Division of Renal Diseases, Department of Medicine, Brown University School of Medicine, Providence, RI, USA. Rgohh@Lifespan.org
Yango
A F
AF
Morrissey
P E
PE
Monaco
A P
AP
Gautam
A
A
Sharma
M
M
McCarthy
E T
ET
Savin
V J
VJ
D000328:Adult; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005923:Glomerulosclerosis, Focal Segmental / Q000453:epidemiology / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000517:prevention & control; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D011507:Proteinuria / Q000453:epidemiology / Q000628:therapy*; D012074:Remission Induction; D012307:Risk Factors; D055502:Secondary Prevention