Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Mar;26(2):e14191.
doi: 10.1111/petr.14191. Epub 2021 Nov 21.

Use of ofatumumab and eplerenone in post-transplant recurrence of FSGS

Namrata G Jain  1 , Justin K Chen  2 , Ruchi Mahajan  3 , Jacqueline Kehoe  3 , Pamela Singer  4 , Dilys Whyte  5 , Andrew S Bomback  6
Affiliations
Case Reports

Use of ofatumumab and eplerenone in post-transplant recurrence of FSGS

Namrata G Jain et al. Pediatr Transplant. 2022 Mar.

Abstract

Background: Focal segmental glomerulosclerosis (FSGS) predisposes patients for risk of recurrent disease in allografts.

Methods: We report a case of a recipient of an unrelated living donor renal transplant and discuss considerations for utilization of ofatumumab and eplerenone in treatment for recurrent FSGS.

Results: The recipient was initially managed with scheduled plasmapheresis, intravenous immunoglobulin (IVIG), and rituximab post-transplant during index hospitalization. With notable recurrence of FSGS noted on kidney transplant biopsy, she was initially treated with additional plasmapheresis sessions leading to downtrend in proteinuria. The patient was then transitioned to LDL-A pheresis, which resulted again in uptrend in proteinuria. This prompted return to scheduled plasmapheresis sessions weekly, leading again to a downtrend in proteinuria. Albumin levels remained within normal range throughout her course. Following initiation of eplerenone and ofatumumab, the patient demonstrated normalization of urine protein:creatinine ratio and remission of FSGS recurrence without need for additional apheresis.

Conclusions: With notable risk of recurrence of FSGS in kidney transplants leading to allograft failure, the use of ofatumumab and eplerenone in conjunction should be considered for management to induce remission.

Keywords: eplerenone; focal segmental glomerulosclerosis; ofatumumab; pediatric transplantation; proteinuria.

PubMed Disclaimer

References

REFERENCES

    1. Kashgary A, Sontrop JM, Li L, et al. The role of plasma exchange in treating post-transplant focal segmental glomerulosclerosis: a systematic review and meta-analysis of 77 case-reports and case-series. BMC Nephrol. 2016;17(1):104.
    1. Fine RN. Recurrence of nephrotic syndrome/focal segmental glomerulosclerosis following renal transplantation in children. Pediatr Nephrol. 2007;22(4):496-502.
    1. Kienzl-Wagner K, Rosales A, Scheidl S, et al. Successful management of recurrent focal segmental glomerulosclerosis. Am J Transplant. 2018;18(11):2818-2822.
    1. Alasfar S, Matar D, Montgomery RA, et al. Rituximab and therapeutic plasma exchange in recurrent focal segmental glomerulosclerosis post kidney transplantation. Transplantation. 2018;102(3):e115-e120.
    1. Shah L, Hooper DK, Okamura D, et al. LDL-apheresis-induced remission of focal segmental glomerulosclerosis recurrence in pediatric renal transplant recipients. Pediatr Nephrol. 2019;34(11):2343-2350.

Publication types

MeSH terms

LinkOut - more resources