Preemptive plasmapheresis and recurrence of FSGS in high-risk renal transplant recipients

Am J Transplant. 2005 Dec;5(12):2907-12. doi: 10.1111/j.1600-6143.2005.01112.x.

Abstract

Recurrent focal segmental glomerulosclerosis (FSGS) following transplantation is ascribed to the presence of a circulating FSGS permeability factor (FSPF). Plasmapheresis (PP) can induce remission of proteinuria in recurrent FSGS. This study addressed the efficacy of pre-transplant PP in decreasing the incidence of recurrence in high-risk patients. Ten patients at high-risk for FSGS recurrence because of rapid progression to renal failure (n = 4) or prior transplant recurrence of FSGS (n = 6) underwent a course of 8 PP treatments in the peri-operative period. Recurrences were identified by proteinuria >3 g/day and confirmed by biopsy. Seven patients, including all 4 with first grafts and 3 of 6 with prior recurrence, were free of recurrence at follow-up (238-1258 days). Final serum creatinine in 8 patients with functioning kidneys averaged 1.53 mg/dL. FSGS recurred within 3 months in 3 patients, each of whom had lost prior transplants to recurrent FSGS. Two of these progressed to end-stage renal disease (ESRD) and the third has significant renal dysfunction. Based on inclusion criteria, recurrence rates of 60% were expected if no treatment was given. Therefore, PP may decrease the incidence of recurrent FSGS in high-risk patients. Definitive conclusions regarding optimal management can only be drawn from larger, randomized, controlled studies.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Child
  • Female
  • Follow-Up Studies
  • Glomerulosclerosis, Focal Segmental / epidemiology
  • Glomerulosclerosis, Focal Segmental / prevention & control*
  • Graft Survival
  • Humans
  • Incidence
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / prevention & control
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Plasmapheresis*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / prevention & control
  • Postoperative Complications / therapy
  • Proteinuria / epidemiology
  • Proteinuria / therapy*
  • Remission Induction
  • Risk Factors
  • Secondary Prevention