The high recurrence rate of
focal segmental glomerulosclerosis (FSGS) in kidney transplant recipients suggests that such patients have a circulating factor that alters glomerular capillary permeability. Serum from patients with FSGS increases glomerular permeability to
albumin. This permeability factor has been partially identified as a
protein. The removal of this
protein by
plasmapheresis (PP) decreases
proteinuria. In this study we report data on the
therapeutic effects of PP in FSGS children with recurrence in the transplanted kidney. Three hundred pediatric (age <19 years) renal transplants were performed, including 21 patients (24 transplants) with FSGS as a cause of
renal failure. Fourteen (58.3%) subjects experienced disease recurrence (
proteinuria >1 g/m(2) per day) within 1 month after
transplantation. Mean age patient was 12 +/- 4.3 years, including 83.3% Caucasians and 70.2% recipients of living donor grafts. Nine were treated with 10 cycles of PP (3 cycles/weekly), initiated immediately after recurrence (<48 hours). Immunosuppression included high doses of
cyclosporine (C(2) levels of 1700-1800 ng/mL),
mycophenolate sodium or mofetil, and
prednisone. Thirteen patients were induced with anti-IL2 receptor
monoclonal antibody (
daclizumab/
basiliximab). Among the patients who underwent PP, five (55.5%) achieved a complete remission and one (12%), a partial remission (1 g/24 hours). There were no cases of remission among the five patients who were not treated with PP. Those who achieved remission after PP experienced no recurrences during the 2.6 +/- 1.4 years follow-up. PP appears to be effective to treat recurrent FSGS following
kidney transplantation. It should be started as soon as possible.