INTRODUCTION: The rate of recurrence of primary focal segmental glomerular sclerosis (FSGS) is problematic, because it often results in very early serious urinary protein secretion and consequent loss of graft function once take place. Any effective preventive regimen for the recurrence is not popular so far. The circulating permeability factors (CFs) is still believed as one of the cause, then therapeutic plasma exchange (TPE) is potent to remove it and prevent the recurrence with high evidence level. On the other hand, maintenance of CD4⁺CD25⁺regulatory T cell (Treg) would be a key to prevent from the recurrence. We herein report the outcome of anti-CD25mAb sparing immunosuppression regimen with TPE for kidney transplant (KT) with FSGS.

METHODS: Out of 685 KT recipients, 10 (male 8, female 2) whose causal disease are primary FSGS pathologically are included in this study. Eight patients were transplanted from living donors, two were from deceased donors. Recipient age was ranged from 19 to 59 (median 31) years old. Their dialysis vintages were 0 to 132 (median 33) months. Induction immunosuppression were comprised of TAC/MMF/steroid and recent two cases used additional everolimus. Two patients also used rituximab because of their ABO incompatibility. All of them did not use basiliximab induction, however; all patients performed one to four sessions of pre-KT TPE (8 ABO compatible patients used Evacure^TM, 2 ABO incombatible did Plasmacure^TM). The clinical outcome and the frequency of recurrence of FSGS was evaluated. The recurrence was diagnosed episode or protocol graft biopsy.

RESULTS: Grafts have been functioning well in nine patients without massive urine protein leakage (follow-up months 22 to 127, median 96 months) and there was no pathological recurrence among them. But one died from acute cardiac failure two months after KT, however; the postmortem graft pathology was completely normal. Their sCr (mg/dl) and urine protein leakage (g/gCr) were 0.8 to 1.53 (median 1.1) and 0.03 to 0.91 (median 0.06). Present data of them are 0.7 to 1.51 (median 1.25) and 0.05 to 4.8 (median 0.3). A patient who excreted massive proteinuria 4.8g/gCr were diagnosed as chronic active antibody mediated rejection due to de novo anti-donor specific HLA antibodies.

CONCLUSION: Our anti-CD25mAb sparing immunosuppression protocol with TPE can prevent FSGS recurrence in our institution. The longer follow-up and nation-wide study should be warranted.

CITATION INFORMATION: Harada H, Wada Y, Fukuzawa N. Anti-CD25mAb Sparing Immunosuppressive Regimen Suppressed Recurrence of Post-Transplant Focal Segmental Glomerular Sclerosis- A Single Center Experience. Am J Transplant. 2017;17 (suppl 3).

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