Combination treatment with plasmapheresis and rituximab for recurrent focal segmental glomerulosclerosis after renal transplantation

Artificial Organs
George TsagalisA Laggouranis

Abstract

Therapy for recurrent focal segmental glomerulosclerosis (FSGS) in the renal allograft is largely based on case reports. The use of plasmapheresis alone (based on its effectiveness in children) appears less effective in adults, reaching a response rate of <40%. Recently, rituximab, an anti-CD20 monoclonal chimeric antibody, showed promising results as rescue therapy in plasmapheresis-resistant recurrent FSGS. However, following rituximab administration, response is variable, often slow and consequently overlooked. We report a series of four cases of recurrent FSGS following renal transplantation successfully treated with a combination of plasmapheresis and rituximab. Complete remission of proteinuria occurred in two and partial remission in the other two patients whereas renal function improved or remained stable. During treatment and the follow-up period (18-60 months) no severe infectious complications were observed. Our data suggest that the combination of plasmapheresis and rituximab is an acceptable treatment in patients with post-transplantation recurrent FSGS.

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Citations

Oct 12, 2012·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Juhi KumarShefali Mahesh
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Jan 30, 2021·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Camille LanaretCyril Garrouste

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