Rituximab and Therapeutic Plasma Exchange in Recurrent Focal Segmental Glomerulosclerosis Postkidney Transplantation

Alasfar, Sami; Matar, Dany; Montgomery, Robert A.; Desai, Niraj M.; Lonze, Bonnie E.; Vujjini, Vikas; Estrella, Michelle M.; Dieck, John Manllo; Khneizer, Gebran; Sever, Sanja; Reiser, Jochen; Alachkar, Nada

doi:10.1097/tp.0000000000002008

Cited by 57 publications

(54 citation statements)

References 26 publications

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“…Randomized controlled trials are lacking, and disease definitions, treatment regimens, and definitions of response to therapy vary greatly. Therapeutic strategies consist of methylprednisolone, high‐dose cyclosporine, cyclophosphamide, PF, plasma filtration, IA, LDL‐apheresis, IVIG, R, and ofatumumab . In this study, we investigated local preventive and/or therapeutic policies of recurrent FSGS after renal transplantation through a survey sent to all members of the ESPN.…”

Section: Introductionmentioning

confidence: 99%

“…Therapeutic strategies consist of methylprednisolone, high-dose cyclosporine, cyclophosphamide, PF, plasma filtration, IA, LDL-apheresis, IVIG, R, and ofatumumab. 17,[19][20][21][22][23][24][25][26] In this study, we investigated local preventive and/or therapeutic policies of recurrent FSGS after renal transplantation through a survey sent to all members of the ESPN.…”

Section: Introductionmentioning

confidence: 99%

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European Society of Pediatric Nephrology survey on current practice regarding recurrent focal segmental glomerulosclerosis after pediatric kidney transplantation

Bouts

Veltkamp

Tönshoff

et al. 2019

Pediatric Transplantation

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Introduction Primary FSGS is an important cause of ESRD in children. FSGS recurrence after kidney transplantation is associated with early graft loss. No guidelines for treatment of FSGS recurrence exist. We conducted a survey to gain insight into variation of treatment between centers. Methods A survey was sent to all members of the ESPN on behalf of the “Renal Transplantation” and “Idiopathic Nephrotic Syndrome” working groups. Results Fifty‐nine nephrologists from 31 countries responded, reporting 807 FSGS patients, with 241 (30%) FSGS recurrences after transplantation. Recurrence varied from 0% to 100% between respondents. Native nephrectomy before or during transplantation was performed, respectively, always (37%), never (39%), or on clinical indication (17%). Half of the respondents started preventive treatment before transplantation, using PF (n = 10); R (n = 4); PF or IA, plus R (n = 9); cyclosporine (n = 2); or unknown (n = 4). Immunosuppressive therapy for patients without known mutations consisted of a combination of steroids, tacrolimus/cyclosporine, and MMF, with or without IL‐2R‐blockade in, respectively, 61% and 86% of the respondents. Sixty‐three percent applied a similar regimen to patients with known mutations. FSGS recurrence was treated with PF or IA, plus R by 66% of respondents; 54% observed no response. Complete remission in >50% of patients was reported by 41% of the respondents. Discussion FSGS recurrence after transplantation is common, but varies greatly between centers. We found great variability in preventive and therapeutic treatment regimens. Future research should focus on predisposing factors, including biopsy findings and genetic mutations, and standardized treatment.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

European Society of Pediatric Nephrology survey on current practice regarding recurrent focal segmental glomerulosclerosis after pediatric kidney transplantation

Bouts

Veltkamp

Tönshoff

et al. 2019

Pediatric Transplantation

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“…The occurrence of FSGS recurrence on the kidney allograft can develop in up to 30% of first kidney transplants [22] and in 85-100% of second kidney transplants when it has recurred on the first transplant [4,23,24]. In our case series, 4 patients had FSGS recurrence on a previous allograft.…”

Section: Discussionmentioning

confidence: 64%

“…Given the significant risk of recurrence of FSGS on the kidney transplant, it does not seem advisable to propose a kidney transplant from a living donor especially in case of recurrence on a first kidney transplant. In addition, the currently used therapies to prevent FSGS recurrence (PP, IA, and rituximab) do not prevent the risk of recurrence of FSGS on the renal graft [22,25].…”

Section: Discussionmentioning

confidence: 99%

“…Alasfar et al [22] performed a retrospective study that included 37 kidney transplant recipients with a high risk for FSGS recurrence and had received preventative therapy with PP and/or rituximab. Twenty-three (62%) of the 37 patients that received preventative therapy developed recurrence compared with 14 (51%) recurrences in the 27 patients that did not receive any therapy (p = 0.21).…”

Section: Discussionmentioning

confidence: 99%

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Immunoadsorption for Recurrent Primary Focal Segmental Glomerulosclerosis on Kidney Allografts: A Single-Center Experience and Literature Review

et al. 2020

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Introduction: Primary focal and segmental glomerulosclerosis (FSGS) frequently reoccurs on kidney transplants and may lead to premature allograft loss. There are no guidelines for treating FSGS recurrence on allografts; treatment is based on apheresis (plasma exchange plasmapheresis [PP], semi-specific immunoadsorption [IA] with reusable columns) plus rituximab. Objective: We aimed to assess the efficacy of IA to treat recurrent FSGS. Methods: We report on 7 patients with recurrent FSGS on kidney allograft (proteinuria ≥3 g/g of urinary creatinine or ≥3 g/day); they all received IA. Our primary objective was to reduce proteinuria by > 50%. Patients' mean age was 45 ± 10 years. Postoperative immunosuppression relied on steroids, mycophenolate mofetil, ta-crolimus, with an induction therapy of basiliximab or antithymocyte globulins. Prophylaxis to prevent FSGS recurrence was either rituximab alone (n = 3), rituximab plus either PP or IA (n = 3), or no treatment (n = 1). Mean follow-up was 20 ± 13 months. There was a median of 72 (14-101) IA sessions per patient, that is, a mean of 14 ± 1 sessions per IA column. Results: At 12 months after starting IA, all patients had partial (n = 6) or complete (n = 1) remission, and allograft survival was 100%. The mean reduction in proteinuria within an IA session was 45 ± 15%. At last follow-up, 2 patients are in remission without IA, 3 patients are in partial remission that is IA dependent, and 2 patients lost their allograft due to FSGS recurrence. The most frequent adverse event was cytomegalovirus reactivation (n = 13), which subsided after valganciclovir therapy. Conclusions: We show that recurrence of FSGS can be controlled long term with IA plus rituximab. However, some patients remained dependent on IA.

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Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue

Schwartz

Winters

Padmanabhan

et al. 2019

J of Clinical Apheresis

1,392

1,195

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The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating and categorizing indications for the evidence‐based use of therapeutic apheresis (TA) in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the committee has incorporated systematic review and evidence‐based approaches in the grading and categorization of apheresis indications. This Eighth Edition of the JCA Special Issue continues to maintain this methodology and rigor in order to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Eighth Edition, like its predecessor, continues to apply the category and grading system definitions in fact sheets. The general layout and concept of a fact sheet that was introduced in the Fourth Edition, has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of TA in a specific disease entity or medical condition. The Eighth Edition comprises 84 fact sheets for relevant diseases and medical conditions, with 157 graded and categorized indications and/or TA modalities. The Eighth Edition of the JCA Special Issue seeks to continue to serve as a key resource that guides the utilization of TA in the treatment of human disease.

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Rituximab and Therapeutic Plasma Exchange in Recurrent Focal Segmental Glomerulosclerosis Postkidney Transplantation

Abstract: Preventative therapies do not decrease the recurrence rate of recurrent FSGS. However, prompt treatment of recurrence with these therapies may result in improved outcomes.

Cited by 57 publications

References 26 publications

European Society of Pediatric Nephrology survey on current practice regarding recurrent focal segmental glomerulosclerosis after pediatric kidney transplantation

European Society of Pediatric Nephrology survey on current practice regarding recurrent focal segmental glomerulosclerosis after pediatric kidney transplantation

Immunoadsorption for Recurrent Primary Focal Segmental Glomerulosclerosis on Kidney Allografts: A Single-Center Experience and Literature Review

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue

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