Apheresis treatment of recurrent focal segmental glomerulosclerosis after kidney transplantation: Re‐analysis of published case‐reports and case‐series

Abstract

A systematic re-analysis of published cases was performed to better define the role of plasmapheresis in the treatment recurrent focal segmental glomerulosclerosis after renal transplantation. Forty-four cases were identified, of which 32 responded to apheresis. The median number of treatments to response was 9. There was no difference between responders and nonresponders in the total number of treatments performed. The presence of sclerosis on biopsy predicted treatment failure. Relapse after first successful treatment was reported in 10 cases. The median number of treatments received was less and the time from diagnosis to first treatment was greater for patients who relapsed than for patients in whom relapse was not reported, but the differences were not statistically significant. On the basis of this analysis, we recommend early treatment after diagnosis with a regimen of three daily plasmapheresis treatments followed by 6 treatments on an every other day basis.

Clinical features and outcomes of kidney transplant recipients with focal segmental glomerulosclerosis recurrence

“…The demographic characteristics and clinical presentation of our cohort are similar other published series. In line with the published literature, our cohort was mainly composed by young male patients . Interestingly, younger patients were more likely to have a pre‐transplant biopsy and this may be due to the easier access of children to the public health system.…”

Combination of pulse methylprednisolone infusions with cyclosporine‐based immunosuppression is safe and effective to treat recurrent focal segmental glomerulosclerosis after pediatric kidney transplantation

“…However, recent attempts to control proteinuria and morbidity with PE or protein A immunoadsorption (IA) have met with limited success. PE or IA can markedly reduce urinary protein excretion or induce CR in some cases, but usually fail to achieve sustained remission (11,12). In our series, one patient with no response to this steroid pulse treatment regimen also showed no response to the following PP therapy.…”

Remission of post-transplant focal segmental glomerulosclerosis with angiotensin receptor blockers

“…Most studies demonstrate remission rates between 50% and 60% with PP, but most patients relapse after stopping PP, suggesting that such treatment induces transient rather than sustained remission[459] and graft survival is significantly inferior to patients without recurrence. [10] It is possible that, despite initial remission of proteinuria, the histological changes continue to progress.…”