Outcomes after Prolonged Therapeutic Plasma Exchange in Pediatric Kidney Transplant Patients with Early Recurrence of Focal Segmental Glomerular Sclerosis
1Division of Abdominal Transplantation, Baylor College of Medicine, Houston, TX, 2Department of Pediatrics, Baylor College of Medicine, Houston, TX, 3Texas Children's Hospital, Houston, TX
Meeting: 2019 American Transplant Congress
Abstract number: B248
Keywords: Graft survival, Nephrotic syndrome, Plasmapheresis, Recurrence
Session Information
Session Name: Poster Session B: Kidney Living Donor: Long Term Outcomes
Session Type: Poster Session
Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Focal segmental glomerular sclerosis (FSGS) is the most common cause of glomerulonephritis leading to end-stage renal disease (ESRD) in pediatric patients. FSGS recurs frequently post-transplant and may lead to graft failure. In recent years, therapeutic plasma exchange (TPE) has become the mainstay aimed at treating FSGS recurrence. Little data is available to support the efficacy of this treatment post-transplant. This study provides one large pediatric center’s 10-year experience with prolonged TPE used to treat pediatric kidney transplant patients with recurrent FSGS.
*Methods: A retrospective cohort study was conducted on all patients with ESRD due to FSGS who received a kidney transplant at a single pediatric center between 2007 and 2018. The primary outcome was graft survival.
*Results: 32 patients, mean age at transplant 15.4±4.3y, 16 male, 17 Hispanic/11 African American/4 Caucasian, met inclusion criteria. 7/32 (22%; mean age 11.1±4.3y; 4 male; 4 Hispanic/1 African American/2 Caucasian) had immediate recurrence of FSGS as nephrotic syndrome after transplant and underwent treatment within 72 hr with steroids, IV rituximab and prolonged TPE (mean duration 7.7 mon, range 0.5-13.5). Only 2/7 (29%) did not respond to therapy and returned to dialysis; one 6yo lost graft function within 2 weeks due to acute vascular rejection; one 18yo had TPE for 11 mon without response. Young age of patients with recurrence (6/7 ≤14y) may have contributed to good response. All 25 patients without post-transplant FSGS recurrence experienced good graft function and 100% 1y-graft survival. In 27 patients with 1y graft survival and available for follow-up (3 transferred care to another center), including 5 with FSGS recurrence responding to therapy, 3y-graft survival was 96% (1 graft loss due to medication non-adherence). Median duration of follow-up was 597 days (range 93-4094).
*Conclusions: Post-transplant recurrence of FSGS occurred in 22% of patients, but almost 70% (5/7) of these responded to therapy with prolonged TPE plus steroids and IV rituximab after transplant and had good graft survival. These results suggest that prolonged TPE plus steroids and IV rituximab is a reasonable treatment approach for those difficult to treat FSGS patients with immediate recurrence of FSGS after transplant.
To cite this abstract in AMA style:
O'Conor DK, Srivaths PR, Hosek K, Gerzina E, Huynh A, Thorsen A, Brewer E, Galvan T. Outcomes after Prolonged Therapeutic Plasma Exchange in Pediatric Kidney Transplant Patients with Early Recurrence of Focal Segmental Glomerular Sclerosis [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-after-prolonged-therapeutic-plasma-exchange-in-pediatric-kidney-transplant-patients-with-early-recurrence-of-focal-segmental-glomerular-sclerosis/. Accessed May 18, 2025.« Back to 2019 American Transplant Congress