Kidney Transplantation for Focal Segmental Glomerulosclerosis: Can We Prevent Its Recurrence? Personal Experience and Literature Review
Background: Primary focal segmental glomerulosclerosis (FSGS) is associated with a high risk of recurrence after kidney transplantation with a major risk of graft loss despite preventive or curative treatments. Aim: to assess graft survival in FSGS kidney-transplant recipients and to compare those t...
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| Format: | Article |
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MDPI AG
2021-12-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/1/93 |
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| author | Hamza Naciri Bennani Lionel Elimby Florian Terrec Paolo Malvezzi Johan Noble Thomas Jouve Lionel Rostaing |
| author_facet | Hamza Naciri Bennani Lionel Elimby Florian Terrec Paolo Malvezzi Johan Noble Thomas Jouve Lionel Rostaing |
| author_sort | Hamza Naciri Bennani |
| collection | DOAJ |
| description | Background: Primary focal segmental glomerulosclerosis (FSGS) is associated with a high risk of recurrence after kidney transplantation with a major risk of graft loss despite preventive or curative treatments. Aim: to assess graft survival in FSGS kidney-transplant recipients and to compare those that had a relapse with those that had no relapse. Patients/Methods: we included 17 FSGS kidney-transplant recipients between January 2000 and January 2020, separated retrospectively into two groups (recurrences: <i>n</i> = 8 patients; no recurrences: <i>n</i> = 9 patients). FSGS recurrence was defined as having proteinuria of ≥3 g/g or urinary creatinine of ≥3 g/day. All patients received an induction therapy; maintenance immunosuppressive therapy at post-transplantation relied on tacrolimus/mycophenolate mofetil/steroids. In order to prevent or treat FSGS recurrence, patients received apheresis sessions plus rituximab. Results: FSGS recurrence rate was 47%. All patients that relapsed with a first graft also relapsed with subsequent grafts. Median time to recurrence was 3 (min: 1; max: 4745) days, despite rituximab/apheresis prophylaxis. Mean age was significantly lower in the relapsers (group 1) than in the non-relapsers (group 2); i.e., 47 ± 11 vs. 58 ± 9 years (<i>p</i> = 0.04). Time to progression to stage 5 chronic kidney disease (CKD) and young age at FSGS diagnosis were lower in group 1 compared to group 2; i.e., 5 (min: 1; max: 26) vs. 2 (min: 1; max: 26) years, and 16 (min: 4; max: 55) vs. 34 (min: 6; max 48) years, respectively. There was no difference between the two groups in terms of progression to CKD stage 5 on the native kidneys, averaging 7 years in both groups (<i>p</i> = 0.99). In group 1, seven patients received rituximab/apheresis prophylaxis, although this did not prevent the recurrence of FSGS. Conclusion: pretransplant prophylaxis with plasmapheresis/rituximab did not appear to reduce the risk of recurrence of primary FSGS on the graft, but could allow remission in the event of recurrence. |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T03:37:03Z |
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| spelling | doaj.art-c90935d928064d1c97579bb250531e932023-11-23T11:43:31ZengMDPI AGJournal of Clinical Medicine2077-03832021-12-011119310.3390/jcm11010093Kidney Transplantation for Focal Segmental Glomerulosclerosis: Can We Prevent Its Recurrence? Personal Experience and Literature ReviewHamza Naciri Bennani0Lionel Elimby1Florian Terrec2Paolo Malvezzi3Johan Noble4Thomas Jouve5Lionel Rostaing6Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, 38000 Grenoble, FranceNephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, 38000 Grenoble, FranceNephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, 38000 Grenoble, FranceNephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, 38000 Grenoble, FranceNephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, 38000 Grenoble, FranceNephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, 38000 Grenoble, FranceNephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, 38000 Grenoble, FranceBackground: Primary focal segmental glomerulosclerosis (FSGS) is associated with a high risk of recurrence after kidney transplantation with a major risk of graft loss despite preventive or curative treatments. Aim: to assess graft survival in FSGS kidney-transplant recipients and to compare those that had a relapse with those that had no relapse. Patients/Methods: we included 17 FSGS kidney-transplant recipients between January 2000 and January 2020, separated retrospectively into two groups (recurrences: <i>n</i> = 8 patients; no recurrences: <i>n</i> = 9 patients). FSGS recurrence was defined as having proteinuria of ≥3 g/g or urinary creatinine of ≥3 g/day. All patients received an induction therapy; maintenance immunosuppressive therapy at post-transplantation relied on tacrolimus/mycophenolate mofetil/steroids. In order to prevent or treat FSGS recurrence, patients received apheresis sessions plus rituximab. Results: FSGS recurrence rate was 47%. All patients that relapsed with a first graft also relapsed with subsequent grafts. Median time to recurrence was 3 (min: 1; max: 4745) days, despite rituximab/apheresis prophylaxis. Mean age was significantly lower in the relapsers (group 1) than in the non-relapsers (group 2); i.e., 47 ± 11 vs. 58 ± 9 years (<i>p</i> = 0.04). Time to progression to stage 5 chronic kidney disease (CKD) and young age at FSGS diagnosis were lower in group 1 compared to group 2; i.e., 5 (min: 1; max: 26) vs. 2 (min: 1; max: 26) years, and 16 (min: 4; max: 55) vs. 34 (min: 6; max 48) years, respectively. There was no difference between the two groups in terms of progression to CKD stage 5 on the native kidneys, averaging 7 years in both groups (<i>p</i> = 0.99). In group 1, seven patients received rituximab/apheresis prophylaxis, although this did not prevent the recurrence of FSGS. Conclusion: pretransplant prophylaxis with plasmapheresis/rituximab did not appear to reduce the risk of recurrence of primary FSGS on the graft, but could allow remission in the event of recurrence.https://www.mdpi.com/2077-0383/11/1/93plasmapheresisrituximabfocal segmental glomerulosclerosisrecurrencekidney transplantationimmunoadsorption |
| spellingShingle | Hamza Naciri Bennani Lionel Elimby Florian Terrec Paolo Malvezzi Johan Noble Thomas Jouve Lionel Rostaing Kidney Transplantation for Focal Segmental Glomerulosclerosis: Can We Prevent Its Recurrence? Personal Experience and Literature Review Journal of Clinical Medicine plasmapheresis rituximab focal segmental glomerulosclerosis recurrence kidney transplantation immunoadsorption |
| title | Kidney Transplantation for Focal Segmental Glomerulosclerosis: Can We Prevent Its Recurrence? Personal Experience and Literature Review |
| title_full | Kidney Transplantation for Focal Segmental Glomerulosclerosis: Can We Prevent Its Recurrence? Personal Experience and Literature Review |
| title_fullStr | Kidney Transplantation for Focal Segmental Glomerulosclerosis: Can We Prevent Its Recurrence? Personal Experience and Literature Review |
| title_full_unstemmed | Kidney Transplantation for Focal Segmental Glomerulosclerosis: Can We Prevent Its Recurrence? Personal Experience and Literature Review |
| title_short | Kidney Transplantation for Focal Segmental Glomerulosclerosis: Can We Prevent Its Recurrence? Personal Experience and Literature Review |
| title_sort | kidney transplantation for focal segmental glomerulosclerosis can we prevent its recurrence personal experience and literature review |
| topic | plasmapheresis rituximab focal segmental glomerulosclerosis recurrence kidney transplantation immunoadsorption |
| url | https://www.mdpi.com/2077-0383/11/1/93 |
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