Treatment of post-transplant recurrent FSGS in children using plasmapheresis and augmentation of immunosuppression

• Published in: BMC nephrology 2022-04, Vol.23 (1), p.131-131, Article 131
• Main Authors: Restrepo, Jaime M, Torres-Canchala, Laura, Londoño, Hernando, Manzi, Eliana, Somers, Michael J G
• Format: Article
• Language: English
• Subjects: Apheresis; Calcineurin; Calcineurin inhibitors; Child; Children & youth; Clinical trials; Creatinine; Cyclophosphamide; Cytomegalovirus; Dialysis; Disease prevention; Diseases; Dosage and administration; Drug dosages; End-stage renal disease; Focal and segmental glomerulosclerosis; Glomerulosclerosis, Focal Segmental - therapy; Health aspects; Humans; Immunosuppression; Immunosuppression Therapy; Kidney diseases; Kidney transplantation; Kidney transplants; Kidneys; Methods; Nephrology; Organ transplant recipients; Patients; Pediatric; Pediatrics; Plasma exchange (Therapeutics); Plasmapheresis; Plasmapheresis - methods; Prospective Studies; Proteinuria; Recurrence; Relapse; Remission; Renal transplantation; Retrospective Studies; Rituximab; Steroid hormones; Steroids; Thromboembolism; Transplantation; Treatment Outcome
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-022-02768-w

Up to 60% of pediatric renal transplant recipients with end-stage renal disease due to primary focal and segmental glomerulosclerosis (FSGS) may develop recurrent disease. Such recurrence is associated with poor prognosis if no remission is achieved. We report a single center experience with a protocol based on plasmapheresis and increased immunosuppression that resulted in a high long-lived remission rate. This retrospective cohort study included consecutive pediatric renal transplant patients with recurrent FSGS treated with a standardized protocol using plasmapheresis and cyclophosphamide to supplement usual post-transplant immunosuppression with calcineurin inhibitors and steroids. Relapse was defined as urinary protein/creatinine ratio > 1.0 g/g and remission as