Immunoadsorbtion and rituximab therapy in a second living-related kidney transplant patient with recurrent focal segmental glomerulosclerosis.
A 29-year-old patient with focal segmental glomerulosclerosis (FSGS) and recurrence of the disease in a living donor kidney transplant received a second living-related kidney graft. She received pre- and postoperative immunoadsorptions and immunosuppression with tacrolimus, mycophenolate mofetil, basiliximab and steroids. Serum creatinine returned to normal values and only minor proteinuria was detected post-transplant (400 mg/24 h). However, recurrence of proteinuria with up to 3.3 g/24 h occurred 2 months after transplantation and the patient underwent intermediate immunoadsorption sessions with immediate reduction of proteinuria for the following year. She then received three doses of rituximab (600 mg, 375 mg/m(2)) that caused immediate reduction of proteinuria with only minimal increase in the following 12 months. Graft function is excellent 2 years after transplantation. These findings suggest that intermittent immunoadsorption combined with B-cell depletion by rituximab treatment induced prolonged reduction of proteinuria in a high-risk patient for recurrence of FSGS in the graft.
Meyer
Tobias N
TN
Department of Internal Medicine, University Hospital Hamburg, Hamburg, Germany. t.meyer@uke.uni-hamburg.de
Thaiss
Friedrich
F
Stahl
Rolf A K
RA
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy* / Q000517:prevention & control / Q000601:surgery; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007167:Immunotherapy; D016030:Kidney Transplantation; D019520:Living Donors; D012086:Reoperation; D000069283:Rituximab; D055502:Secondary Prevention
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab