Successful Treatment of Recurrent Focal Segmental Glomerulosclerosis After Transplantation in Children: A Single-Center Experience

Alhasan, Khalid; Al‐Herbish, Abdullah S.; Osman, Ahmed; Kari, JA; Al-Mojalli, Hamad

doi:10.1016/j.transproceed.2019.01.004

Cited by 3 publications

(1 citation statement)

References 26 publications

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“…However, patients with steroid-resistant FSGS usually also fail to respond to treatment with rituximab 65 . Rituximab has not been studied as initial therapy for ppfFSGS, but it has beneficial effects in relapsing minimal change disease and in post-transplantation recurrent FSGS 66,67 .…”

Section: Suppressing Permeability Factor Formationmentioning

confidence: 99%

Therapeutic trials in adult FSGS: lessons learned and the road forward

Vriese

Wetzels²,

Glassock

et al. 2021

Nat Rev Nephrol

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Section: Suppressing Permeability Factor Formationmentioning

confidence: 99%

Therapeutic trials in adult FSGS: lessons learned and the road forward

Vriese

Wetzels²,

Glassock

et al. 2021

Nat Rev Nephrol

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Abatacept

2019

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Management and long-term outcome of recurrent idiopathic FSGS in pediatric kidney transplant recipients

Plonsky-Toder,

Pollack,

Tibi

et al. 2024

Sci Rep

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Focal segmental glomerulosclerosis (FSGS) is a major cause of pediatric kidney failure. Most cases of FSGS in children are idiopathic and have a high risk of post-transplantation recurrence and graft loss. Common treatments for recurrent FSGS (rFSGS) post-transplantation include plasmapheresis, immunoadsorption, and/or immunomodulatory therapy. This study retrospectively evaluated the efficacy and safety of early plasmapheresis followed by rituximab for inducing and maintaining remission in rFSGS. Between 2014 and 2023, 8 of 65 pediatric kidney transplant recipients at our center were diagnosed with idiopathic FSGS. rFSGS was diagnosed based on nephrotic range proteinuria with no other cause and managed with plasmapheresis. Rituximab therapy was used for those who did not achieve complete remission with prolonged plasmapheresis or remained plasmapheresis dependent. 6 of 8 (75%) transplant recipients with idiopathic FSGS experienced rFSGS. All patients achieved partial or complete remission with plasmapheresis, with response times ranging from 8 to 379 days (median 13 days). Rituximab therapy was introduced for 5 plasmapheresis-dependent patients, leading to sustained remission and cessation of plasmapheresis in 3 patients, while 2 showed improved proteinuria and reduced plasmapheresis frequency. Adverse effects included rituximab-induced serum sickness in one patient and one mild allergic reaction. One patient experienced graft loss due to humoral rejection, but no grafts were lost to rFSGS, and all other grafts remained functional over an average follow-up of 50 months. Early plasmapheresis followed by rituximab therapy effectively induces remission in most post-transplantation rFSGS cases, is well tolerated, and prevents graft loss. Larger studies are needed to confirm these findings.

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Successful Treatment of Recurrent Focal Segmental Glomerulosclerosis After Transplantation in Children: A Single-Center Experience

Cited by 3 publications

References 26 publications

Therapeutic trials in adult FSGS: lessons learned and the road forward

Therapeutic trials in adult FSGS: lessons learned and the road forward

Abatacept

Management and long-term outcome of recurrent idiopathic FSGS in pediatric kidney transplant recipients

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