Successful Management of Post Transplant Focal Segmental Glomerulosclerosis With Plasma Exchange and Rituximab
1Kidney and Transplant Centre, Imperial Healthcare NHS Trust, London, United Kingdom
2Department of Histopathology, Imperial Healthcare NHS Trust, London, United Kingdom.
Meeting: 2015 American Transplant Congress
Abstract number: 359
Keywords: Glomerulonephritis, Graft failure, Kidney transplantation
Session Information
Session Name: Concurrent Session: Glomerulonephritis/Recurrent Disease
Session Type: Concurrent Session
Date: Tuesday, May 5, 2015
Session Time: 2:15pm-3:45pm
Presentation Time: 2:51pm-3:03pm
Location: Room 121-AB
Background: Post-transplant Focal Segmental Glomerulosclerosis (FSGS) is associated with renal allograft loss. Currently, optimal treatment remains controversial. We propose a management protocol that includes treatment with Plasma Exchange (PEX) and Rituximab (RTX).
Methods: This was a prospective study, aiming to examine the efficacy and safety of PEX and RTX in the management of post-transplant FSGS. All patients received a steroid sparing immunosuppressive regime with Alemtuzumab induction and tacrolimus monotherapy. The post transplant FSGS treatment protocol consisted of RTX (total of 2gr over 2 infusions, 2 weeks apart) and monthly cycles of 5 PEX over 7 days for 6 months. Partial remission was defined as 50% reduction of proteinuria, while complete remission as proteinuria <1g/day or uPCR<100. A post treatment biopsy was performed in 7 patients.
Results: We treated 10 transplant recipients (9 male, mean age 52,6 +/-10,7 years) with biopsy proven post-transplant FSGS. 7/10 patients had late (>3 months) and 3/10 early (<3 months) post-transplant FSGS. The mean time to diagnosis post transplant was 7.6 (1.3 –34.6) months. On histology, 2 patients' biopsies showed collapsing, 3 tip lesion and 5 NOS variants of FSGS. All patients received 2gr of RTX and remained B-cell deplete for 6.6+/-3.4 months. 9 patients completed 6 cycles of PEX, while 1 patient had only one cycle of PEX, as he did not tolerate further treatment. Mean follow up after FSGS diagnosis was 16.7+/-7.2 months. 8 out of 10 patients achieved remission upon completion of PEX (5 complete / 3 partial). During the follow up period, one patient relapsed, and ended up on dialysis and one died from unrelated complications, at 11 and 16 months post diagnosis, respectively. There was a significant reduction in mean uPCR between diagnosis (281.2+/-149 mg/mmol) and last follow up (44.8+/-40 mg/mmol) in the patients with complete remission (p=0.02). There was no significant decline in eGFR in the 7 relapse-free responders at the end of follow up (53.3+/-6.8 from 54.7+/-16.3ml/min, p=0.1)
Conclusion: Post-transplant FSGS treatment with RTX and PEX appears to be safe, well tolerated and achieves an increased rate of remission. Further studies are needed to determine to define the optimal timing, dose, and duration of treatment.
To cite this abstract in AMA style:
Koutroutsos K, Charif R, Roufosse C, Galliford J, Taube D, Loucaidou M. Successful Management of Post Transplant Focal Segmental Glomerulosclerosis With Plasma Exchange and Rituximab [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/successful-management-of-post-transplant-focal-segmental-glomerulosclerosis-with-plasma-exchange-and-rituximab/. Accessed May 10, 2025.« Back to 2015 American Transplant Congress