Background: Recurrence of Focal Glomerulosclerosis (FSGS) after kidney transplantation is associated with poor graft survival. We present results from a concise diagnostic and management protocol that proposed treatment of post transplant FSGS with Plasma Exchange (PEX) and Rituximab (RTX).

Methods: We compared the outcomes between 10 consecutive kidney transplant recipients (KTR) with post-transplant FSGS that were treated with a protocol based on histology for diagnosis and that consisted of RTX (total of 2gr over 2 infusions, 2 weeks apart) and monthly cycles of 5 PEX over 7 days for 6 months to a historic control group of 9 KTR's with post-transplant FSGS. Patients with a primary diagnosis of FSGS as well as transplant recipients with non-biopsy proven primary diagnosis that developed post transplantation proteinuria with evidence of segmental or focal glomerulosclerosis on light microscopy or diffuse effacement of podocyte foot processes on electron microscopy (EM) were included.

Results: 10 consecutive patients (8 male, mean age 51 years, range 23-67) were treated with the new protocol (group A) while the historic control group consisted of 9 KTR's(6 male, mean age 54 years, range 34-71) (group B). The mean time to diagnosis was 6.8 (0.1 – 34.6) for group A and 13.5(1.5-40.3) months for group B. All group A patients received treatment with at least 2gr of RTX in total and PEX, while group B received a variety of treatments; IVIG+PEX (n=4), PEX (n=4) or no treatment (n=1). 9 out of 10 patients in group A achieved remission after the conclusion of treatment (4 complete and 5 partial), while in Group B 5 out of 9 patients achieved remission (2 complete and 3 partial). During the follow up period, 1 patient from each group relapsed, and ended up requiring dialysis at 11 and 24 months post diagnosis, respectively. In relapse free responders there was a significant reduction in mean uPCR between diagnosis (645+/-667 mg/mmol) and 1 year (126+/-130 mg/mmol) in group A (p=0.026), but not in group B. (777+/-867 mg/mmol vs 152+/-158 mg/mmol, p=0.17)

Conclusion: The present study demonstrates the significant benefits in the treatment of post transplant FSGS with a uniform diagnostic and treatment protocol with PEX and RTX.

CITATION INFORMATION: Koutroutsos K, Charif R, Moran L, Moss J, Cook T, Roufosse C, Taube D, Loucaidou M. Insights into the Treatment of Post-Transplant Focal Glomerulosclerosis: Experience Gained from a Concise Diagnostic and Management Protocol. Am J Transplant. 2016;16 (suppl 3).

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