INTRODUCTION

Recurrence of focal and segmental glomerulosclerosis (FSGS) after renal transplantation is a characteristic complication of the disease that occurs in one third of the cases. It has been suggested that preemptive rituximab (RTX) may prevent recurrences in patients at risk but there is no general agreement about factors identifying these patients.

MATERIALS AND METHODS

We perform a multicenter retrospective cohort study including 93 kidney transplants between years 2000 and 2014 with biopsy-proven FSGS as the underlying primary disease; patients with genetic or secondary causes were excluded.

The aims of the study are to identify those factors that predict proteinuria recurrence and to analyze the efficacy of rituximab as preventive treatment in patients at risk.

RESULTS

Fifteen patients (16.1%) presented a FSGS recurrence. When the analysis was restricted to those patients presenting with nephrotic syndrome at baseline, the incidence of recurrence increased to 44.1%.

By multivariate analysis, the only significant risk factor for recurrence was the presence of complete nephrotic syndrome with hypoalbuminemia at diagnosis. Among 34 patients at risk for recurrence rituximab was infused at transplantation in 12. Clinical and analytical characteristics were similar in both groups. No differences were found in the number of recurrences: 6/12 (50%) among RXT-treated patients and 9/22 (40.9%) among non-treated patients (p = 0.610).

Proteinuria remission after different treatments, most of them including plasmapheresis, was observed in 71.4% of patients. The addition of RTX to plasmapheresis did not increase efficacy.

FSGS recurrence had a remarkable impact on graft survival, with 53% functioning grafts at the end of follow-up among patients who had suffered recurrence versus 88,5% in those who did not (p = 0.004); graft survival of FSGS recurrent patients achieving proteinuria remission after treatment was similar to that of patients without recurrence.

DISCUSSION

In conclusion, the presence of hypoalbuminemia at the onset of the disease is the main predicting factor for FSGS recurrence after transplantation. Rituximab does not prevent FSGS recurrence in patients at risk.

CITATION INFORMATION: Auñon P., Polanco N., Perez M., Rodrigo E., Sancho A., Pascual J., Andres A., Praga M. Preemptive Rituximab in Focal and Segmental Glomerulosclerosis Patients at Risk for Recurrence after Transplantation Am J Transplant. 2017;17 (suppl 3).

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