Individualized scheme of immunoadsorption for the recurrence of idiopathic focal segmental glomerulosclerosis in the graft: a single center experience

Lionaki, Sophia; Vlachopanos, Georgios; Georgalis, Argyrios; Liapis, George; Skalioti, Chrysanthi; Zavos, G.; Boletis, John

doi:10.3109/0886022x.2015.1015366

Cited by 25 publications

(16 citation statements)

References 50 publications

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“…proteinuria after post-transplant year 1, concurrent to PE frequency reduction, had been successfully treated with Rituximab ® (2 doses) and PE sessions bimonthly, obtaining a complete proteinuria remission in the 34 ± 6.7 mo of follow-up. A positive effect is also described for plasma absorption in some papers [34][35][36][37] , but further studies are needed to define the potential additive benefit in comparison with PE.…”

Section: Update On Pathogenetic Mechanismsmentioning

confidence: 99%

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: Update On Pathogenetic Mechanismsmentioning

confidence: 99%

Update on the treatment of focal segmental glomerulosclerosis in renal transplantation

Messina¹,

Gallo²,

Mella³

et al. 2016

WJT

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“…TPE and IA in primary and recurrent FSGS were shown to be effective. IA may have advantages in patients' safety and side effects, especially compared with high volume TPE (2,4).…”

Section: Discussionmentioning

confidence: 99%

“…Treatment choices include therapeutic plasma exchange (TPE), cyclosporine in high doses, or rituximab. Immunoadsorption (IA) can induce remission of primary FSGS and of recurrent FSGS after renal transplantation (1)(2)(3)(4).…”

Section: Dear Editormentioning

confidence: 99%

“…Thus, IA should be considered in recurrent FSGS as it can provide an effective therapy with a low rate of complications. Treatment intensity can be tailored individually to the patients' needs(3,4). Silvius Frimmel 1 , Steffen R. Mitzner 1,2 and Sebastian Koball 1 1 Department of Tropical Medicine, Infectious Diseases and Nephrology, University of Rostock Medical School, and 2 Fraunhofer Institute for Cell Therapy and Immunology, Rostock, Germany Email: silvius.frimmel@med.uni-rostock.de…”

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confidence: 99%

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Immunoadsorption as a Long‐Term Therapy in Recurrent Focal Segmental Glomerulosclerosis After Renal Transplantation

2016

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“…IA seems to be as effective as plasmapheresis in the treatment of FSGS recurrence and has the advantage of allowing a more specific clearance without the substitution of fresh frozen plasma. In a study that included 12 patients with FSGS recurrence after transplant, systematic IA alone was shown to be sufficient to induce remission in two-thirds of the patients [14]. …”

Section: Discussionmentioning

confidence: 99%

Efficacy of the Combination of Immunoadsorption and Rituximab for Treatment in a Case of Severe Focal and Segmental Glomerulosclerosis Recurrence after Renal Transplantation

2018

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Background/Aims: We present a case of a male patient with severe recurrence of focal and segmental glomerulosclerosis (FSGS) after transplant. Methods: Before the transplant he was treated with plasma exchange. Massive proteinuria was detected post-transplantation and plasma exchanges were performed without response. We administered 5 doses of Rituximab (375 mg/m²) and partial remission was achieved. Proteinuria relapse occurred 1 year post-transplant, so Immunoadsorption (IA) was started instead of plasma exchange with reduction of proteinuria. Later, 2 new episodes of proteinuria relapse were detected and treated by increasing the number of IA sessions and administering new cycles of Rituximab. After achieving partial remission, IA was reduced to one session every 7–10 days as maintenance therapy. Results: Despite the fact of the severe recurrence, renal function and proteinuria remain stable over 8 years after the transplantation was performed. Conclusion: Combination of maintenance IA and cycles of Rituximab is an effective treatment for aggressive forms of FSGS recurrence after renal transplantation.

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Individualized scheme of immunoadsorption for the recurrence of idiopathic focal segmental glomerulosclerosis in the graft: a single center experience

Abstract: IA was shown efficacious in a small series of patients with recurrent FSGS in the graft. Renal function remained stable in eight of the 12 patients with FSGS recurrence.

Cited by 25 publications

References 50 publications

Update on the treatment of focal segmental glomerulosclerosis in renal transplantation

Update on the treatment of focal segmental glomerulosclerosis in renal transplantation

Immunoadsorption as a Long‐Term Therapy in Recurrent Focal Segmental Glomerulosclerosis After Renal Transplantation

Efficacy of the Combination of Immunoadsorption and Rituximab for Treatment in a Case of Severe Focal and Segmental Glomerulosclerosis Recurrence after Renal Transplantation

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