Date: Saturday, May 2, 2015
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
The estimated recurrence rate of focal segmental glomerulosclerosis (FSGS) after kidney transplantation is approximately 30%. Relapse occurring immediately after transplantation is refractory to treatment and has a particularly poor prognosis. In order to prevent immediate recurrence, we use an immunosuppressive protocol comprising prophylactic rituximab and/or plasmapheresis (PP). This study retrospectively examined the clinical outcomes of kidney transplantation in recipients with FSGS who received our prophylactic treatment.
The subjects were 38 patients with FSGS who underwent kidney transplantation at our institute between 2000 and 2013. In the induction phase, most recipients received tacrolimus- or cyclosporine-based immunosuppression including methylprednisolone and mycophenolate mofetil. After 2002, all patients received basiliximab perioperatively. Among the 38 patients, 23 additionally received prophylactic rituximab (RIT), which has been used at our institution since 2005, and underwent PP prior to kidney transplantation. Ten patients underwent PP, without prophylactic RIT. Five patients received neither RIT nor PP.
FSGS recurred in 5 of 23 (21.7%), 4 of 10 (40.0%), and 2 of 5 (40.0%) recipients who received RIT and PP, only PP, and neither, respectively. The recurrence rate was markedly lower in patients who received both prophylactic treatments, although there were no significant differences among treatments. Five recipients suffered graft loss: 4 due to chronic antibody-mediated rejection, and 1 due to FSGS recurrence. Serum creatinine levels 2 and 6 years post-transplantation were significantly lower in patients who received both prophylactic treatments compared to others (p < 0.05).
Prophylactic RIT administration with PP appears to be effective in the prevention of FSGS recurrence and maintenance of graft function after kidney transplantation.
To cite this abstract in AMA style:Okumi M, Miyauchi Y, Yagisawa T, Unagami K, Toki D, Omoto K, Ishida H, Tanabe K. Excellent Outcomes of Prophylactic Rituximab Administration With Plasmapheresis in Kidney Transplant Recipients With Focal Segmental Glomerulosclerosis [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/excellent-outcomes-of-prophylactic-rituximab-administration-with-plasmapheresis-in-kidney-transplant-recipients-with-focal-segmental-glomerulosclerosis/. Accessed November 13, 2019.
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