Post-transplant focal segmental glomerulosclerosis refractory to plasmapheresis and rituximab therapy

El-Firjani, Ali; Hoar, Stephanie; Karpinski, Jolanta; Bell, Robert; Deschênes, Marie-Josée; Knoll, Greg

doi:10.1093/ndt/gfm616

Cited by 30 publications

(18 citation statements)

References 5 publications

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“…On the other hand, Rituximab ® is one of the most interesting agents proposed to date for treatment of FSGS recurrence; but, again, several limitations lie in the related literature, including the use of a surrogate end-point of disease activity (i.e., clinical/not histological definition of recurrent FSGS in the study by Fornoni et al [21] ), short followup [76,77] , and evidence of absence of positive effects [62,[87][88][89][90][91][92][93][94] . Furthermore, the Rituximab ® dose is another matter of debate, and the question remains: Should the classic scheme borrowed from hematologic protocols (4 doses of 375 mg/m 2 each) or a shorter regimen (titrated to the minimal level necessary to obtain B cell depletion) be adopted?…”

Section: Discussionmentioning

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: Discussionmentioning

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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“…A protective role of prophylactic PE before transplantation has also been reported (65,66). Several single-case reports pointed out the benefit of rituximab when given alone or in combination with PE (67-72), but failures were also reported (73)(74)(75)(76). Currently, PE combined with high-dose calcineurin inhibitors with or without rituximab seems to be the most promising approach, but further controlled trials are needed to define the optimal therapeutic regimens to treat recurrence of FSGS (77).…”

Section: Fsgsmentioning

confidence: 99%

Posttransplant Recurrence of Primary Glomerulonephritis

Ponticelli

Glassock

2010

Clinical Journal of the American Society of Nephrology

209

166

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All forms of primary GN may recur after kidney transplantation and potentially jeopardize the survival of the graft. IgA nephritis (IgAN) may recur in approximately one third of patients, more frequently in younger patients and in those with a rapid progression of the original disease. However, with the exception of few patients with rapid progression, there is no evidence that recurrence of IgAN has a deleterious effect on graft survival at least up to 10 years. Recurrence of focal segmental glomerulosclerosis (FSGS) is often associated with nephrotic proteinuria and is more frequent in children, in patients with rapid progression of the original disease, and in those who lost a previous transplant from recurrence. The natural course of recurrent FSGS is usually unfavorable. Early and intensive plasmapheresis may obtain complete or partial response in several patients. Good results have also been reported with rituximab. Idiopathic membranous nephropathy (IMN) may recur in 30% to 40% of patients. The graft survival in patients with IMN is not different than that of patients with other renal diseases. Good results with rituximab have been reported. Membranoproliferative GN (MPGN) may recur in 27% to 65% of patients. The recurrence is more frequent and the prognosis is more severe in type II MPGN. Although recurrent GN is relatively frequent and may worsen the outcome of renal allografts in some patients, its effect is diluted by several other risk-factors that may have a greater effect than recurrent GN on the long-term graft survival.

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“…Since the year 2000, numerous case reports and small studies of the efficacy of rituximab in treating FSGS have been published [62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78]. The larger case series are summarized in Table 3.…”

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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Post-transplant focal segmental glomerulosclerosis refractory to plasmapheresis and rituximab therapy

Cited by 30 publications

References 5 publications

Update on the treatment of focal segmental glomerulosclerosis in renal transplantation

Update on the treatment of focal segmental glomerulosclerosis in renal transplantation

Posttransplant Recurrence of Primary Glomerulonephritis

Recurrent focal segmental glomerulosclerosis after kidney transplantation

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