title: Success with plasmapheresis treatment for recurrent focal segmental glomerulosclerosis in pediatric renal transplant recipients.
abstract: FSGS recurs in approximately 30% of transplanted kidneys and may lead to graft loss. We retrospectively examined the efficacy of early and intensive PP without additional IS in pediatric kidney transplant patients with recurrent FSGS at our center. Seven of 24 patients (29%) had nephrotic proteinuria and histologic evidence of FSGS recurrence within 1-5 days post-transplantation. PP was initiated early after transplantation and initially performed daily until sustained decline in proteinuria. PP frequency was then individually tapered according to proteinuria. Recurrent FSGS in all seven patients responded to a four- to 32-wk course of PP. Two of seven patients had a second recurrence of FSGS, and both recurrences remitted after an additional 3-6 wk of PP. Median observation period was 4.5 yr (0.8-16.3 yr). Complete remission of recurrent FSGS has been sustained in all seven patients, and all patients have stable graft function with recent plasma creatinine <1.5 mg/dL in six of seven patients. Most recent urine protein/creatinine is 0.13-0.61 mg/mg in six of seven patients. One patient has heavy proteinuria secondary to chronic allograft nephropathy 16 yr post-transplant. Intensive and prolonged PP, when initiated early in the post-operative period, is effective in treating recurrent FSGS and preventing graft loss without the use of additional immunosuppressants.
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Caroline
authors.initials: C
authors.lastname: Straatmann
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Kallash
authors.forename: Mary
authors.initials: M
authors.lastname: Killackey
authors.forename: Franca
authors.initials: F
authors.lastname: Iorember
authors.forename: Diego
authors.initials: D
authors.lastname: Aviles
authors.forename: Oluwatoyin
authors.initials: O
authors.lastname: Bamgbola
authors.forename: Thomas
authors.initials: T
authors.lastname: Carson
authors.forename: Sander
authors.initials: S
authors.lastname: Florman
authors.forename: Matti V
authors.initials: MV
authors.lastname: Vehaskari
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000652:urine; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000473:pathology / Q000628:therapy*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007674:Kidney Diseases / Q000473:pathology; D016030:Kidney Transplantation; D008297:Male; D010956:Plasmapheresis; D011507:Proteinuria / Q000175:diagnosis; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D003404:Creatinine
keywords: focal segmental glomerular sclerosis; graft function; kidney transplantation; plasmapheresis; recurrent disease; treatment