title: Individualized scheme of immunoadsorption for the recurrence of idiopathic focal segmental glomerulosclerosis in the graft: a single center experience.
abstract: OBJECTIVE
  To explore the role of immunoadsorption (IA) for the treatment of idiopathic focal segmental glomerulosclerosis (FSGS) recurrence in the renal allograft, if applied in a personalized manner.
  
  
  METHODS
  We studied patients with end-stage renal disease (ESRD) due to idiopathic FSGS, transplanted between 2001 and 2010. Patients with FSGS recurrence were treated with daily sessions of IA for the first week, followed by an every other day scheme and then individualized tapering until discontinuation. Complete remission was defined as a reduction of 24-h proteinuria to ≤ 0.5 g/day and partial remission as a reduction of 24-h proteinuria to 50% or more from baseline.
  
  
  RESULTS
  Of the 18 renal transplant recipients with ESRD due to idiopathic FSGS, 12 (66.7%) experienced disease recurrence in a mean time of 0.75 months post-transplantation (KTx), with a mean proteinuria of 8.9 g/day at the time of recurrence. The mean recipient age was 30.8 years; the mean donor age was 47.4 years, while living related donors provided the allograft in seven cases. Four of the patients received therapy with rituximab in addition to IA. During a mean time of follow-up of 48.3 months, seven patients (58.3%) achieved complete remission, and five (41.7%) partial remission. At the end of follow-up, eight patients (66.7%) had functioning grafts, being in sustained remission, in contrast to four patients (33.3%), who ended up in ESRD because of FSGS recurrence.
  
  
  CONCLUSIONS
  IA was shown efficacious in a small series of patients with recurrent FSGS in the graft. Renal function remained stable in eight of the 12 patients with FSGS recurrence.
authors.affiliation: a Department of Nephrology & Transplantation Unit , Laiko Hospital , Athens , Greece .
authors.forename: Sophia
authors.initials: S
authors.lastname: Lionaki
authors.forename: George
authors.initials: G
authors.lastname: Vlachopanos
authors.forename: Argyrios
authors.initials: A
authors.lastname: Georgalis
authors.forename: George
authors.initials: G
authors.lastname: Liapis
authors.forename: Chrysanthi
authors.initials: C
authors.lastname: Skalioti
authors.forename: George
authors.initials: G
authors.lastname: Zavos
authors.forename: John N
authors.initials: JN
authors.lastname: Boletis
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis / Q000379:methods; D011507:Proteinuria / Q000188:drug therapy*; D012008:Recurrence; D012074:Remission Induction; D000069283:Rituximab / Q000627:therapeutic use; D014019:Tissue Donors; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D000069283:Rituximab
keywords: FSGS; immunoadsorption; kidney transplantation