title: Case report: successful treatment of recurrent focal segmental glomerulosclerosis with a novel rituximab regimen.
abstract: Focal segmental glomerulosclerosis (FSGS) is the cause of renal failure in more than 10% of pediatric patients undergoing renal transplantation. Recurrent FSGS is a major cause of pediatric allograft failure, with the risk increasing for patients undergoing retransplantation. Standard therapy for recurrent posttransplantation FSGS includes the use of intensive plasmapheresis (PP) in conjunction with cyclophosphamide or high-dose cyclosporine. However, many patients exhibit refractory disease, with rapid progression to allograft loss despite these interventions. Prior studies have reported conflicting data on the efficacy of adding rituximab therapy to the standard treatment regimen for recurrent posttransplantation FSGS. Here we present a successful therapeutic protocol with rapid elimination of PP after initiation of rituximab therapy for an adolescent patient with recurrent FSGS in the immediate postoperative period. The patient has maintained excellent allograft function through 12 months posttransplantation.
authors.affiliation: Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA. zoe-stewart@uiowa.edu
authors.forename: Z A
authors.initials: ZA
authors.lastname: Stewart
authors.forename: R
authors.initials: R
authors.lastname: Shetty
authors.forename: R
authors.initials: R
authors.lastname: Nair
authors.forename: A I
authors.initials: AI
authors.lastname: Reed
authors.forename: P D
authors.initials: PD
authors.lastname: Brophy
mesh_terms: D000293:Adolescent; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D012008:Recurrence; D012086:Reoperation; D000069283:Rituximab; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab