Preventing recurrence of focal segmental glomerulosclerosis following renal transplantation: a case report.
While the recurrence of FSGS in a primary renal transplant has been well studied, strategies to prevent subsequent recurrence in later transplants, has not been well formulated. This is important considering that one center's experience with adults reported an initial recurrence rate of 57% with reoccurrence of 37% in subsequent transplants. However, renal function was maintained in 62% (1). In pediatrics, data from a single-center reported 100% recurrence of FSGS in the second allograft after an initial recurrence of 52% (2). Two commentaries reviewing such data, one each in adults and pediatrics, suggested that the benefits of living-related donation might not be realized in patients with FSGS because of this frequent recurrence (3, 4). Here, we report a patient who was considered to be at very high risk for post-transplant recurrence of FSGS, because of the established risk factors, who was successfully retransplanted after a course of pretransplant plasmapheresis, followed by post-transplant plasmapheresis and the use of cyclosporine. Eighteen months post-transplant, he has no proteinuria and his serum creatinine is 1.2 mg/dL.
Couloures
Kevin
K
Division of Pediatric Nephrology, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90048, USA.
Pepkowitz
Samuel H
SH
Goldfinger
Dennis
D
Kamil
Elaine S
ES
Puliyanda
Dechu P
DP
D000293:Adolescent; D016572:Cyclosporine / Q000627:therapeutic use; D005923:Glomerulosclerosis, Focal Segmental / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D010956:Plasmapheresis; D055502:Secondary Prevention
D007166:Immunosuppressive Agents; D016572:Cyclosporine