Successful treatment of recurrent focal segmental glomerulosclerosis with a low dose rituximab in a kidney transplant recipient

Cho, Jang‐Hee; Lee, Jong-Hak; Park, Ga-Young; Lim, Jeong-Hoon; Kim, Jun-Seop; Kang, Yoon‐Jung; Kwon, Owen; Choi, Ji-Young; Park, Sun-Hee; Kim, Yong-Lim; Kim, Hyung-Kee; Huh, Seung; Kim, Chan‐Duck

doi:10.3109/0886022x.2014.882238

Cited by 22 publications

(18 citation statements)

References 22 publications

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“…Cho et al [80] Rituximab ® (100 mg, 1 dose) 1 patient (≥ 18 yr) Complete remission Yabu et al [87] [104] Abatacept (1 dose; 10 mg/kg) in patient 1; belatacept (3 doses 10 mg/kg or continuative treatment) in patients 2-5…”

Section: Messina M Et Al Focal Segmental Glomerulosclerosis In Renamentioning

confidence: 99%

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Update on the treatment of focal segmental glomerulosclerosis in renal transplantation

Messina¹,

Gallo²,

Mella³

et al. 2016

WJT

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Focal segmental glomerulosclerosis (FSGS) represents one of the most severe glomerular diseases, with frequent progression to end-stage renal disease and a high rate of recurrence in renal allografts (30%-50%). Recurrent FSGS portends a negative outcome, with the hazard ratio of graft failure being two-fold higher then that of other glomerulonephritis. Two patterns of clinical presentations are observed: Early recurrence, which is characterized by massive proteinuria within hours to days after implantation of the renal graft, and late recurrence, which occurs several months or years after the transplantation. Many clinical conditions have been recognized as risk factors for recurrence, including younger age, rapid progression of the disease to end-stage renal disease on native kidneys, and loss of previous renal allografts due to recurrence. However, much less is known about the incidence and risk factors of the so-called "de novo " type of FSGS, for which sufferers are transplanted patients without disease on native kidneys; but, rapid development of allograft failure is frequently observed. Management of both forms is challenging, and none of the approaches proposed to date have been demonstrated as consistently beneficial or effective. In the present review we report an update on the available therapeutic strategies for FSGS in renal transplantation within the context of a critical overview of the current literature.

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Section: Messina M Et Al Focal Segmental Glomerulosclerosis In Renamentioning

confidence: 99%

“…Despite successful results having been obtained [77][78][79][80][81][82][83][84][85][86] , other studies have shown a transient or even absent response to Rituximab ® [62,[87][88][89][90][91][92][93][94] (Table 1).…”

Section: Novel Therapeutic Optionsmentioning

confidence: 99%

Update on the treatment of focal segmental glomerulosclerosis in renal transplantation

Messina¹,

Gallo²,

Mella³

et al. 2016

WJT

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“…However, the question of rituximab dosing should be considered open, especially in view of a recent case report documenting effective treatment of recurrent FSGS with a single 100-mg dose of the antibody [80]. An additional concern with the use of rituximab is the side-effect profile.…”

Section: Treatmentmentioning

confidence: 99%

Recurrent focal segmental glomerulosclerosis after kidney transplantation

2015

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Focal segmental glomerulosclerosis (FSGS) is an important cause of glomerular disease in children and adolescents and nearly 50 % of affected patients will progress to endstage kidney disease over a 5 to 10-year period. Unfortunately, there is no established treatment for disease in the native kidney. Moreover, up to 55 % of patients develop recurrent disease after receiving a kidney transplant, with a substantially higher risk in patients who have already experienced recurrent disease in a prior transplant. A number of clinical and laboratory factors have been identified as risk factors for this complication. In addition, new investigations into podocyte biology and circulating permeability factors have shed light on the cause of recurrent the disease. While a number of novel therapeutic agents have been applied in the management of this problem, there still is no proven treatment. In this review, we summarize recent advances in the epidemiology, pathophysiology, and treatment of recurrent FSGS in pediatric patients who have received a kidney transplant.

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“…Recently, small studies have shown that a single rituximab dose was efficacious for treatment of primary/relapsing IgA, FSGS, MN, MPGN, or minimal change disease [24,25,26]. Pharmacokinetic studies have illustrated that lower doses of rituximab are effective in prompt and sustained depletion of B-cells up to 12 months, with count recovery beginning between 3 and 6 months [25,26,27].…”

Section: Introductionmentioning

confidence: 99%

Single-Dose Rituximab for Recurrent Glomerulonephritis Post-Renal Transplant

et al. 2015

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Background/Aims: Post-renal transplant recurrent glomerulonephritis (GN) contributes to allograft loss. Rituximab treatment has been used in a multidose strategy with variable efficacy and toxicity. We investigated a novel single-dose approach. Methods: A single center, retrospective, cohort study was conducted between January 1998 and April 2012 among renal allograft recipients with recurrent GN treated with rituximab (cases) or without (controls). The primary outcome was complete response (CR, urine protein/creatinine ratio (UP/C) <0.3). Secondary outcomes included partial response (PR >50% reduction in UP/C), response relapse, treatment-response by GN type, acute rejection incidence, time to graft loss, and infection incidence. Results: The median dose of rituximab was 200 mg per patient. Of 20 rituximab cases and 13 controls, CR was achieved in eight (40%) versus four (31%), respectively (p = 0.72). Three subjects in each group achieved PR (p = 0.66). Response relapse was similar between the two groups (p = 0.47). Significantly more subjects with recurrent membranous nephropathy (MN) achieved CR with rituximab treatment (p = 0.029). Acute rejection was lower in the rituximab group versus controls (n = 0 vs. 4; p = 0.046). The mean time to graft loss was much later in the rituximab group (35 months, (95% CI 33-37)) versus controls (29 months, (95% CI 24-35)) at 36 months (p = 0.04). There was no infection increase in rituximab-treated subjects (p = 0.16). Conclusion: Single-dose rituximab for treatment of recurrent GN was associated with less subsequent rejection and longer time to graft loss without increased infection, but was no more effective than regimens not using rituximab at 36-months except those with recurrent membranous GN.

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Successful treatment of recurrent focal segmental glomerulosclerosis with a low dose rituximab in a kidney transplant recipient

Cited by 22 publications

References 22 publications

Update on the treatment of focal segmental glomerulosclerosis in renal transplantation

Update on the treatment of focal segmental glomerulosclerosis in renal transplantation

Recurrent focal segmental glomerulosclerosis after kidney transplantation

Single-Dose Rituximab for Recurrent Glomerulonephritis Post-Renal Transplant

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