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Observational Study
. 2018 Mar;102(3):e115-e120.
doi: 10.1097/TP.0000000000002008.

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

Sami Alasfar  1 , Dany Matar  2 , Robert A Montgomery  3 , Niraj Desai  4 , Bonnie Lonze  3 , Vikas Vujjini  5 , Michelle M Estrella  6   7 , John Manllo Dieck  1 , Gebran Khneizer  8 , Sanja Sever  7 , Jochen Reiser  9 , Nada Alachkar  1
Affiliations
Observational Study

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

Sami Alasfar et al. Transplantation. 2018 Mar.

Abstract

Background: Focal segmental glomerulosclerosis (FSGS) is a common cause of end-stage renal disease with a high rate of recurrence after kidney transplantation. Several factors, such as white race, rapid progression, and previous allograft failure due to recurrence, were found to be risks of recurrence. Data are limited on the benefits of rituximab and/or therapeutic plasma exchange (TPE) in preventing recurrence. In this study, we sought to assess the efficacy of rituximab and TPE for the prevention and treatment of recurrent FSGS after kidney transplantation.

Methods: We enrolled 66 patients with FSGS in this prospective observational study and followed their outcomes. Patients with high risk for recurrence received preventative therapy with TPE and/or rituximab.

Results: Twenty-three (62%) of the 37 patients who received preventative therapy developed recurrence compared with 14 (51%) recurrences of the 27 patients who did not receive any therapy (P = 0.21). There was a trend for less relapse when rituximab was used as a therapy for recurrent FSGS (6/22 vs 9/18, P = 0.066). We used a clinical score of 5 values to assess the prediction of FSGS recurrence. A score of 3 or more had a predictive receiver operating characteristic curve of 0.72. Treatment with TPE and/or rituximab resulted in better allograft survival than historical studies. Allograft failure because of recurrent FSGS occurred in only 6 (9%) patients.

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

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Figures

Figure 1
Figure 1
ROC curves for detecting patients with highest risk of recurrence stratified by their pretransplant risk scoring system
Figure 2
Figure 2
Kaplan Meier curve of allografts’ survival in patients with FSGS recurrence
See this image and copyright information in PMC

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