BACKGROUND: Post-transplant recurrence of primary focal segmental glomerulosclerosis (FSGS) has been attributed to a persistent circulating permeability factor. Prophylactic peri-operative plasmapheresis (PP) has been used to decrease the high recurrence rate but few protocols have included preoperative sessions. Here, we evaluated the efficacy of a protocol including a preoperative PP.
METHODS: We retrospectively reviewed 12 patients with biopsy-proven primary FSGS who underwent kidney transplantation between 2001 and 2011. A course of one preoperative PP and 28 postoperative PP over 6 months was performed. All patients received the same immunosuppressive regimen based on basiliximab, tacrolimus, mycophenolate mofetil and prednisone.
Seven patients were identified as high-risk for recurrence because of prior transplant recurrence of FSGS (n=2) or rapid progression to renal failure (n=2) or both (n=3).
Recurrence was defined as nephrotic-range proteinuria (> 3 g/day or 2 g/liter) in the absence of urinary tract infection or any sign of rejection on the allograft biopsy.
RESULTS: FSGS recurred in 6 of 12 allografts, between day 2 and 11 in five patients and at 4 years post-transplant in one patient. One of the six recurring recipients had both risk factors whereas two of them had a rapid progression to renal failure. Early biopsies within the first three months showed normal glomeruli or mild signs of FSGS in optic microscopy. Two patients lost their transplant to recurrence at 4.2 months and 10.8 years.
Six patients remained free of recurrence at follow-up (median follow up time: 36.0 months, range 9.4 83.7 months).
Among the five patients who had recurred on a previous graft, only one suffered from a new recurrence despite prophylactic PP therapy.
CONCLUSIONS: Our results confirm that preoperative PP appears to be more effective in patients with prior recurrence while its indication in other cases remains to be demonstrated. Larger randomized studies are required to evaluate the prophylactic effect of PP in all FSGS recipients.
To cite this abstract in AMA style:Bruley D, Croze L, Burroni B, Pinel N, Malvezzi P, Zaoui P. Recurrence of Focal Segmental Glomerulosclerosis after Renal Transplantation: Who Benefits from Preemptive Plasmapheresis? [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/recurrence-of-focal-segmental-glomerulosclerosis-after-renal-transplantation-who-benefits-from-preemptive-plasmapheresis/. Accessed October 25, 2020.
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