Effect of pre-and postoperative plasmapheresis on posttransplant recurrence of focal segmental glomerulosclerosis in children

Transplantation. 2001 Mar 15;71(5):628-33. doi: 10.1097/00007890-200103150-00008.


Background: Posttransplant recurrence is frequent in patients who received renal transplantation for focal segmental glomerulosclerosis (FSGS). The recurrence has been ascribed to a circulating permeability factor or factors. We have used plasmapheresis (PP) to treat recurrent FSGS and also studied whether preoperative PP is effective in preventing recurrence of FSGS.

Methods: We retrospectively analyzed 21 allografts of 20 patients with nephrotic syndrome and biopsyproven FSGS. They were divided into two groups depending on whether they had prophylactic PP; a prophylactic (n=15) and a nonprophylactic group (n=6). PP was performed two to three times prophylactically and therapeutically until proteinuria was markedly reduced. In each session, 50-75 ml/kg of the patient's plasma was exchanged with 5-8% albumin.

Results: FSGS recurred in 9 of 21 allografts, 4 of 6 in the nonprophylactic group, and 5 of 15 in the prophylactic group. Therapeutic PP was performed in seven of nine recurrent patients without definite adverse effect, with satisfactory results except in one patient. Children lost proteinuria after 6 to > 100 sessions of PP and the number correlated with the pretreatment level of proteinuria. The mean follow-up periods were 62.7 and 41.6 months for the prophylactic and nonprophylactic groups, respectively. At the last follow-up, 66.7% of relapsing and 81.8% of nonrelapsing patients had a functioning graft.

Conclusion: PP appears to be effective for the prevention and treatment of posttransplant recurrence of FSGS, although further consideration of cost/benefit and risks is required before a conclusive judgement can be made.

MeSH terms

  • Child
  • Child, Preschool
  • Glomerulosclerosis, Focal Segmental / pathology
  • Glomerulosclerosis, Focal Segmental / prevention & control*
  • Glomerulosclerosis, Focal Segmental / surgery*
  • Glomerulosclerosis, Focal Segmental / urine
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Kidney / pathology
  • Kidney / physiopathology
  • Kidney Transplantation*
  • Plasmapheresis*
  • Postoperative Care*
  • Postoperative Period
  • Preoperative Care*
  • Proteinuria / therapy
  • Recurrence
  • Retrospective Studies
  • Treatment Outcome