Effect of pre-and postoperative plasmapheresis on posttransplant recurrence of focal segmental glomerulosclerosis in children.

Abstract

BACKGROUND:

Posttransplant recurrence is frequent in patients who received renal transplantation for focal segmental glomerulosclerosis (FSGS). The recurrence has been ascribed to a circulating permeability factor or factors. We have used plasmapheresis (PP) to treat recurrent FSGS and also studied whether preoperative PP is effective in preventing recurrence of FSGS.

METHODS:

We retrospectively analyzed 21 allografts of 20 patients with nephrotic syndrome and biopsyproven FSGS. They were divided into two groups depending on whether they had prophylactic PP; a prophylactic (n=15) and a nonprophylactic group (n=6). PP was performed two to three times prophylactically and therapeutically until proteinuria was markedly reduced. In each session, 50-75 ml/kg of the patient's plasma was exchanged with 5-8% albumin.

RESULTS:

FSGS recurred in 9 of 21 allografts, 4 of 6 in the nonprophylactic group, and 5 of 15 in the prophylactic group. Therapeutic PP was performed in seven of nine recurrent patients without definite adverse effect, with satisfactory results except in one patient. Children lost proteinuria after 6 to > 100 sessions of PP and the number correlated with the pretreatment level of proteinuria. The mean follow-up periods were 62.7 and 41.6 months for the prophylactic and nonprophylactic groups, respectively. At the last follow-up, 66.7% of relapsing and 81.8% of nonrelapsing patients had a functioning graft.

CONCLUSION:

PP appears to be effective for the prevention and treatment of posttransplant recurrence of FSGS, although further consideration of cost/benefit and risks is required before a conclusive judgement can be made.

• Authors: T Ohta, H Kawaguchi, M Hattori, Y Komatsu, Y Akioka, M Nagata, H Shiraga, K Ito, K Takahashi, N Ishikawa, K Tanabe, Y Yamaguchi, K Ota
• Journal: Transplantation (Transplantation) Vol. 71 Issue 5 Pg. 628-33 (Mar 15 2001) ISSN: 0041-1337 [Print] United States
• PMID: 11292291 (Publication Type: Journal Article)

Topics

• Child
• Child, Preschool
• Glomerulosclerosis, Focal Segmental (pathology, prevention & control, surgery, urine)
• Humans
• Incidence
• Infant
• Infant, Newborn
• Kidney (pathology, physiopathology)
• Kidney Transplantation
• Plasmapheresis
• Postoperative Care
• Postoperative Period
• Preoperative Care
• Proteinuria (therapy)
• Recurrence
• Retrospective Studies
• Treatment Outcome