title: The role of plasma exchange in treating post-transplant focal segmental glomerulosclerosis: A systematic review and meta-analysis of 77 case-reports and case-series.
abstract: Evidence on the role of plasma exchange for treating recurrent post-transplant focal segmental glomerulosclerosis (FSGS) comes largely from individual cases and uncontrolled series. We conducted a systematic review and meta-analysis to estimate the remission rate after treatment with plasma exchange, and to determine if remission varied with patient or treatment characteristics.
  
  
  
  We searched MEDLINE, EMBASE, Science Citation Index Expanded, and the Conference Proceedings Citation Index (Science and BIOSIS) for studies of patients with post-transplant recurrent FSGS who were treated with plasma exchange after recurrence (1950-2012). Of 678 studies screened, 77 met our inclusion criteria: 34 case reports (45 patients) and 43 case series (378 patients). We extracted patient-level data from each study and used random-effects models to calculate remission, defined as proteinuria <3.5 g/day (partial) or <0.5 g/day (complete).
  
  
  
  The overall remission rate in 423 patients with outcome data was 71 % (95 % CI: 66 % to 75 %). In 235 patients with data on age, remission was similar for adults and children: 69.1 % (95 % CI: 59.6 % to 77.2 %) and 70.2 % (95 % CI: 61.1 % to 77.9 %). Males were more likely to achieve remission (OR = 2.85; 95 % CI: 1.44 to 5.62) and patients treated within 2 weeks of recurrence showed a trend towards higher likelihood of remission (OR = 2.16; 95 % CI: 0.93 to 5.01). Proteinuria >7 g/day at recurrence was inversely associated with remission (OR = 0.43; 95 % CI: 0.19 to 0.97). Age and type of kidney transplant (living vs. deceased) did not associate with remission.
  
  
  
  In this systematic review of patients with recurrent post-transplant FSGS, 71 % of patients achieved full or partial remission after treatment with plasma exchange; however, extensive missing data and lack of a control group limit any conclusions on causality.
authors.affiliation: Division of Nephrology, Department of Medicine, Western University, London, Canada.|Department of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.|Victoria Hospital, 800 Commissioners Road East, A2-343, London, ON, Canada, N6A 5W9.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Kashgary
authors.affiliation: Department of Epidemiology and Biostatistics, Western University, London, Canada.|Kidney Clinical Research Unit, London Health Sciences Centre, 339 Windermere Road, London, ON, Canada, N6A 5A5.|Victoria Hospital, 800 Commissioners Road East, A2-343, London, ON, Canada, N6A 5W9.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Sontrop
authors.affiliation: Kidney Clinical Research Unit, London Health Sciences Centre, 339 Windermere Road, London, ON, Canada, N6A 5A5.|Victoria Hospital, 800 Commissioners Road East, A2-343, London, ON, Canada, N6A 5W9.
authors.forename: Lihua
authors.initials: L
authors.lastname: Li
authors.affiliation: Kidney Clinical Research Unit, London Health Sciences Centre, 339 Windermere Road, London, ON, Canada, N6A 5A5.|Victoria Hospital, 800 Commissioners Road East, A2-343, London, ON, Canada, N6A 5W9.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Al-Jaishi
authors.affiliation: Division of Nephrology, Department of Medicine, Western University, London, Canada.|Victoria Hospital, 800 Commissioners Road East, A2-343, London, ON, Canada, N6A 5W9.
authors.forename: Zainab N
authors.initials: ZN
authors.lastname: Habibullah
authors.affiliation: Division of Nephrology, Department of Medicine, Western University, London, Canada.|Department of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
authors.forename: Roaa
authors.initials: R
authors.lastname: Alsolaimani
authors.affiliation: Division of Nephrology, Department of Medicine, Western University, London, Canada. William.Clark@lhsc.on.ca.|Kidney Clinical Research Unit, London Health Sciences Centre, 339 Windermere Road, London, ON, Canada, N6A 5A5. William.Clark@lhsc.on.ca.|Victoria Hospital, 800 Commissioners Road East, A2-343, London, ON, Canada, N6A 5W9. William.Clark@lhsc.on.ca.
authors.forename: William F
authors.initials: WF
authors.lastname: Clark
mesh_terms: D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000150:complications / Q000601:surgery / Q000628:therapy*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D010951:Plasma Exchange; D011184:Postoperative Period; D011507:Proteinuria / Q000209:etiology / Q000652:urine; D012008:Recurrence; D012074:Remission Induction; D012737:Sex Factors
keywords: Focal segmental glomerulosclerosis; Kidney transplantation; Plasma exchange; Plasmapheresis; Systematic review