Background: suPAR is elevated in patients (pts) with FSGS. Increased levels were associated with recurrence in transplanted kidneys. Previous studies suggested a causative role in FSGS pathology. Plasmapheresis (PPH) is an accepted treatment for pts with recurrence of FSGS. The aim of this study was (1) to evaluate the efficacy of suPAR elimination by PPH and (2) to estimate the rebound effect after treatment.

Methods: This prospective single center study investigated the effect of 41 PPH sessions in 4 pts with histologically proven FSGS (mean age: 41±22 years; 3 pts were male; 80±13 kg; baseline creatinine of 2.4±1.1 mg/dL, proteinuria of 4.3±3.2 mg/24h). The suPAR concentration was analysed before and after PPH in the course of the therapy. Each PPH consisted of 2.5 litres plasma volume that was pheresed before replacement with 4% human albumin. Additional therapy of FSGS recurrence consisted of cyclosporine A i.v., MMF and steroids. suPAR concentration was determined by ELISA.

Results: PPH therapy effectively eliminated the suPAR molecule, with a mean of 40% reduction of suPAR concentration.

Despite the significant elimination rate, a substantial rebound effect was found, with suPAR levels reaching 100,1±16,2 % of the pre-treatment levels after on average 13,9 days. This effect occurred independently of the intensity of PPH. Even the most intensive regimen of PPH (three sessions per week) was accompanied by a rebound effect of 94% compared to values before treatment. This rebound persisted even after more than four weeks of intense treatment.

Conclusions: The suPAR molecule which has been linked to FSGS pathology can be eliminated effectively by PPH. The effect is limited, as a significant rebound leads to suPAR concentrations in the pre-treatment range even during the most intensive PPH regimes.

« Back to 2013 American Transplant Congress