Therapeutic plasma exchange, rituximab and steroids in pediatric kidney transplant recipients with early recurrence of FSGS: a single large pediatric hospital experience
Maya Guhan1, Daniel O'Conor1, Eileen Brewer2, Poyyapakkam Srivaths2, Kirti Bhakta2, Kathleen Hosek3, Marielle Farone2, Andrew Thorsen1, Elizabeth Gerzina1, Anh Huynh1, Nhu Thao Galvan1.
1Division of Abdominal Transplantation, Baylor College of Medicine, Houston, TX, United States; 2Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States; 3Outcomes and Impact Service, Texas Children's Hospital, Houston, TX, United States
Focal segmental glomerular sclerosis (FSGS) is the most common glomerular disease leading to end-stage renal disease (ESRD) in children. FSGS frequently recurs after kidney transplant and may cause graft failure. Therapeutic plasma exchange (TPE), rituximab and steroids have been used to treat post-transplant FSGS recurrence, but limited data is available to support their combined efficacy.
We conducted a retrospective cohort study of all kidney transplant recipients at a single pediatric center between 2007 and 2018 to determine frequency of FSGS and early recurrence of nephrotic syndrome within 4 days of transplant. Primary outcome was graft survival and secondary outcome was remission of nephrotic syndrome.
FSGS was the indication for renal transplant in 11% of cases(n=29). Of these, 24% of patients had early FSGS recurrence after transplant(n=7). Treatment was at the discretion of the treating physician, but generally included TPE, rituximab and steroids. Five responded; the other two returned to chronic dialysis. 22 patients without recurrence experienced 100% 1-year graft survival. For all FSGS recipients, including those with recurrence, 3-year graft survival was 94.4%. 5/7(71%) of recipients with recurrence achieved partial or full remission of nephrotic syndrome following treatment.
This study, the largest to uniformly employ the combination of TPE, rituximab and high-dose steroids, supports the efficacy of this treatment for pediatric patients with FSGS recurrence.
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