Plasmapheresis for Prevention of Recurrent Focal Segmental Glomerulosclerosis of Kidney Allograft in Adult Recipients

Abstract

Nephrotic syndrome due to focal segmental glomerulosclerosis (FGS) frequently recurs even after renal transplantation and may cause renal allograft failure. From January 1983 though April 1995, 11 adult recipients with primary FGS received 11 kidney transplants at our institution, and 3 of them were treated with pretransplant plasma exchange (PE). Other patients did not receive any preoperative PE, and 4 patients lost their grafts due to recurrent FGS (50%). PE was completed 3 times before the transplantation to prevent posttransplant recurrence of FGS. Two recipients did not have any proteinuria or graft dysfunction without posttransplant PE. One patient had mild proteinuria immediately after transplantation, and histological examination showed recurrent FGS. The patient has been undergoing PE once a month (2 years posttransplant). Her renal function is excellent (sCr 1.2 mg/dl), and her FGS is being well controlled by PE. PE seems to be effective for the prevention of the recurrence of FGS following renal transplantation.

Preoperative Low-Density Lipoprotein Apheresis for Preventing Recurrence of Focal Segmental Glomerulosclerosis after Kidney Transplantation

“…Iguchi et al [ 31 ] reported that the beneficial effect of pretreatment by plasma exchange was suggested. The possibility of decreasing or absorbing the potent pathogenic permeability factor might be expected in both LDL apheresis and plasma exchange.…”

Protocol biopsies for focal segmental glomerulosclerosis treated with plasma exchange and rituximab in a renal transplant patient

“…Even with widespread application of plasmapheresis for recurrent FSGS, relapse rates remain high, and patients may become plasmapheresis dependent (1, 2). In the case of preemptive plasmapheresis, some reports have indicated trends toward reductions in recurrence rates and a resulting improvement in graft survival benefit among high‐risk patients (8, 9). According to a literature review (Tables 3 and 4), preemptive plasmapheresis seemed to provide better outcomes for remission of FSGS when conducted along with use of rituximab.…”

“…Recurrent FSGS immediately after renal transplantation is attributed to circulating permeability factor (5). Plasmapheresis is thus used as the initial therapy for recurrent FSGS (6, 7) and also as preemptive therapy to prevent further recurrence (8, 9). Even with more widespread application of plasmapheresis, relapse rates remain high and frequently lead to graft loss (1, 2).…”

The Role of Plasmapheresis in the Treatment of Focal Segmental Glomerulosclerosis (FSGS)

“…Iguchi et al also tried prophylactic plasmapheresis (3 sessions) before transplantation in three patients, only one of whom had recurrence of proteinuria compared to four out of eight not receiving plasmapheresis (15). Two of the patients who had recurrence of FSGS had further plasmapheresis with one showing relative remission and stable renal function, while the other developing graft failure.…”