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. 2019 Oct 3;14(1):139-148.
doi: 10.1093/ckj/sfz120. eCollection 2021 Jan.

Pre-emptive rituximab in focal and segmental glomerulosclerosis patients at risk of recurrence after kidney transplantation

Pilar Auñón  1 , Natalia Polanco  1 , María José Pérez-Sáez  2 , Emilio Rodrigo  3 , Asunción Sancho  4 , Julio Pascual  2 , Amado Andrés  1 , Manuel Praga  1   5
Affiliations

Pre-emptive rituximab in focal and segmental glomerulosclerosis patients at risk of recurrence after kidney transplantation

Pilar Auñón et al. Clin Kidney J. .

Abstract

Background: The recurrence of proteinuria after kidney transplantation (KT) is a characteristic complication of focal segmental glomerulosclerosis (FSGS). It has been suggested that pre-emptive rituximab might prevent recurrences in patients at risk, but there is no agreement about which factors might help to identify such patients.

Methods: We studied 93 kidney transplants with biopsy-proven idiopathic FSGS in order to analyse if preventive rituximab treatment could decrease recurrences in patients at risk.

Results: Fifteen patients (16.1%) presented a recurrence after KT, but when we restricted the analysis to the 34 patients presenting nephrotic syndrome at primary disease onset, the recurrence diagnosis rate increased to 44.1%. All patients with recurrence had complete nephrotic syndrome at the time of diagnosis. After multivariate adjustment, the only significant risk factor for recurrence was the presence of complete nephrotic syndrome at diagnosis. Twelve of the 34 patients at risk for recurrence received rituximab at the time of transplantation. Clinical and analytical characteristics were similar in all patients at risk. The number of recurrences was similar among treated (50%) and non-treated patients (40.9%).

Conclusions: Nephrotic syndrome with hypoalbuminaemia at diagnosis is the most important feature to identify patients at risk of recurrence. Our data suggest that pre-emptive rituximab is not effective to prevent FSGS recurrences.

Keywords: focal segmental glomerulosclerosis; kidney transplantation; recurrence; rituximab.

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Figures

FIGURE 1
FIGURE 1
Pre-emptive rituximab in patients at risk for recurrence because of the presence of nephrotic syndrome at baseline.
FIGURE 2
FIGURE 2
Graft survival according to recurrence with remission, recurrence without remission or non-recurrence.
See this image and copyright information in PMC

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