Many pediatric centers utilize a variety of protocols including scheduled plasmapheresis to prevent the dreaded recurrence of focal segmental glomerulosclerosis (FSGS) post-transplant. But the effectiveness of this expensive, invasive process of plasmapheresis in the prevention of FSGS recurrence has been poorly studied in children. We retrospectively reviewed all pediatric cases of FSGS in our center that received a kidney transplant from 1984-2005 and compared the transplant and patient outcomes of those transplanted 2006-2015 who received peri-transplant plasmapheresis.

Of the 57 FSGS cases transplanted, 31 and 26 were transplanted before and after 2006 respectively. The cohorts differed significantly in keeping with the center immunosuppression protocol changes and prior to 2006, the recipients were significantly younger. All children with FSGS transplanted after 2006 underwent 3 and 1 sessions of 1 plasma volume / exchange plasmapheresis with fresh frozen plasma replacement prior to the transplant in living and deceased donors respectively, in addition to 5 sessions of every other day post-transplant pheresis. One of the patients also received 2 doses of rituximab following plasmapheresis. Incidence of FSGS recurrence, time to FSGS recurrence and death-censored graft survival was not significantly different between the two eras (p 0.3; p 0.06; p 0.2 respectively).

In summary, peri-transplant plasmapheresis was not effective in the prevention of recurrent FSGS post-transplant compared to historic controls.

CITATION INFORMATION: Verghese P, Rheault M, Chinnakotla S, Jackson S, Matas A, Chavers B. Is Peri-Transplant Plasmapheresis Effective in the Prevention of Recurrence of FSGS? Am J Transplant. 2017;17 (suppl 3).

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