Preemptive plasmapheresis and recurrence of FSGS in high-risk renal transplant recipients.

Abstract

Recurrent focal segmental glomerulosclerosis (FSGS) following transplantation is ascribed to the presence of a circulating FSGS permeability factor (FSPF). Plasmapheresis (PP) can induce remission of proteinuria in recurrent FSGS. This study addressed the efficacy of pre-transplant PP in decreasing the incidence of recurrence in high-risk patients. Ten patients at high-risk for FSGS recurrence because of rapid progression to renal failure (n = 4) or prior transplant recurrence of FSGS (n = 6) underwent a course of 8 PP treatments in the peri-operative period. Recurrences were identified by proteinuria >3 g/day and confirmed by biopsy. Seven patients, including all 4 with first grafts and 3 of 6 with prior recurrence, were free of recurrence at follow-up (238-1258 days). Final serum creatinine in 8 patients with functioning kidneys averaged 1.53 mg/dL. FSGS recurred within 3 months in 3 patients, each of whom had lost prior transplants to recurrent FSGS. Two of these progressed to end-stage renal disease (ESRD) and the third has significant renal dysfunction. Based on inclusion criteria, recurrence rates of 60% were expected if no treatment was given. Therefore, PP may decrease the incidence of recurrent FSGS in high-risk patients. Definitive conclusions regarding optimal management can only be drawn from larger, randomized, controlled studies.

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@article{Gohh2005PreemptivePA, title={Preemptive plasmapheresis and recurrence of FSGS in high-risk renal transplant recipients.}, author={Reginald Y. Gohh and Angelito F Yango and Paul Morrissey and Anthony P. Monaco and Amitabh Gautam and Meera Sharma and Ellen T. McCarthy and Virginia J Savin}, journal={American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons}, year={2005}, volume={5 12}, pages={2907-12} }