| 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. |
| Authors | R Y Gohh, A F Yango, P E Morrissey, A P Monaco, A Gautam, M Sharma, E T McCarthy, V J Savin
(Affiliation: Division of Renal Diseases, Department of Medicine, Brown University School of Medicine, Providence, RI, USA. Rgohh at Lifespan.org)
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| Journal | American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
(Am J Transplant)
Vol. 5
Issue 12
Pg. 2907-12
(Dec 2005)
ISSN: 1600-6135 Denmark |
| PMID | 16303004
(Publication Type: Clinical Trial, Journal Article, Research Support, N.I.H., Extramural)
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| Topics |
- Adult
- Child
- Female
- Follow-Up Studies
- Glomerulosclerosis, Focal Segmental
(epidemiology, prevention & control)
- Graft Survival
- Humans
- Incidence
- Kidney Failure, Chronic
(epidemiology, prevention & control)
- Kidney Transplantation
- Male
- Middle Aged
- Plasmapheresis
- Postoperative Complications
(epidemiology, prevention & control, therapy)
- Proteinuria
(epidemiology, therapy)
- Recurrence
(prevention & control)
- Remission Induction
- Risk Factors
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