title: Successful treatment of recurrent focal segmental glomerulosclerosis after kidney transplantation by plasmapheresis and rituximab.
abstract: A 22-year-old patient whose primary kidney disease was focal segmental glomerulosclerosis (FSGS) developed severe recurrence of proteinuria (up to 57 g/24 h) immediately after a haploidentic living donor kidney transplantation despite pre-operative plasmapheresis. The immunosuppressive treatment consisted of tacrolimus, mycophenolate mofetil, basiliximab and steroids. He underwent 10 plasmapheresis sessions in the first 3-week post-transplantation. In addition, he received 2 i.v. doses of rituximab (RTX) 600 mg (375 mg/m(2)) on days 7 and 15. Proteinuria decreased below nephrotic range at day 14 and serum creatinine returned progressively to normal values. A short course of oral ciclophosphamide (100 mg/j) was administrated between days 22 and 40 and three additional plasmapheresis sessions on days 34, 39 and 49. This strategy allowed obtaining sustained full remission of the nephrotic syndrome (NS) and excellent graft function, which persists over 2 years after transplantation. No notable adverse events related to RTX or plasmapheresis were observed. This case suggests that RTX associated with plasmapheresis may be an effective treatment of recurrent NS because of FSGS.
authors.affiliation: Department of Medicine, Division of Nephrology, Hôpital Cantonal Universitaire, Geneva, Switzerland.
authors.forename: Dan
authors.initials: D
authors.lastname: Hristea
authors.forename: Karine
authors.initials: K
authors.lastname: Hadaya
authors.forename: Nicola
authors.initials: N
authors.lastname: Marangon
authors.forename: Léo
authors.initials: L
authors.lastname: Buhler
authors.forename: Jean
authors.initials: J
authors.lastname: Villard
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Martin
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D003131:Combined Modality Therapy; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D010956:Plasmapheresis; D011183:Postoperative Complications / Q000628:therapy; D011507:Proteinuria / Q000517:prevention & control; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D000069283:Rituximab