title: Plasma Exchange for the Recurrence of Primary Focal Segmental Glomerulosclerosis in Adult Renal Transplant Recipients: A Meta-Analysis.
abstract: Background. Posttransplant recurrence of primary focal segmental glomerulosclerosis (rFSGS) in the form of massive proteinuria is not uncommon and has detrimental consequences on renal allograft survival. A putative circulating permeability factor has been implicated in the pathogenesis leading to widespread use of plasma exchange (PLEX). We reviewed published studies to assess the role of PLEX on treatment of rFSGS in adults. Methods. Eligible manuscripts compared PLEX or variants with conventional care for inducing proteinuria remission (PR) in rFSGS and were identified through MEDLINE and reference lists. Data were abstracted in parallel by two reviewers. Results. We detected 6 nonrandomized studies with 117 cases enrolled. In a random effects model, the pooled risk ratio for the composite endpoint of partial or complete PR was 0,38 in favour of PLEX (95% CI: 0,23-0,61). No statistical heterogeneity was observed among included studies (I (2) = 0%, p = 0,42). On average, 9-26 PLEX sessions were performed to achieve PR. Renal allograft loss due to recurrence was lower (range: 0%-67%) in patients treated with PLEX. Conclusion. Notwithstanding the inherent limitations of small, observational trials, PLEX appears to be effective for PR in rFSGS. Additional research is needed to further elucidate its optimal use and impact on long-term allograft survival.
authors.affiliation: Department of Nephrology, "Asklepieion" General Hospital, Vas. Pavlou Avenue 1, 16673 Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Vlachopanos
authors.affiliation: Department of Transplantation Immunology and Nephrology, University Hospital Basel, Spitalstrasse 21, 4056 Basel, Switzerland.
authors.forename: Argyrios
authors.initials: A
authors.lastname: Georgalis
authors.affiliation: 1st Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias Street 75, 11527 Athens, Greece.
authors.forename: Harikleia
authors.initials: H
authors.lastname: Gakiopoulou