Abstract: SA-PO525

Incidence and Treatment of Recurrent FSGS Following Kidney Transplantation in Patients with Pre-Emptive Plasmapheresis

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Harris, Meredith, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Hooper, David K., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Background

Focal Segmental Glomerulosclerosis (FSGS) is a leading cause of end stage renal disease (ESRD) in children. Unfortunately, it reoccurs in up to half of patients following kidney transplantation. Pre-emptive therapeutic plasma exchange (TPE) has been suggested as a way to prevent recurrent FSGS, although few studies have evaluated its’ efficacy. Once FSGS does recur, therapies such as rituximab and cyclosporine have been tried in combination with TPE to induce remission, but few studies report the efficacy of these therapies.

Methods

We performed retrospective chart review of 258 patients transplanted at CCHMC from May 2003 through November 2016 and identified patients with FSGS as the primary diagnosis. We then identified all patients who received at least one TPE treatment prior to kidney transplantation and evaluated the risk of FSGS recurrence. FSGS recurrence was compared between patients with 1 TPE treatment vs. ≥ 3 treatments. For patients with recurrent FSGS, we compared treatment in patients with early vs. late remission.

Results

35/258 (14%) transplants had FSGS as the primary diagnosis, 20 of which received pre-emptive TPE. 11/20 (55%) patients with pre-emptive TPE experienced FSGS recurrence at a median of 3 days (range 1-90) post-transplant. 2/5 patients (40%) who received 1 pre-emptive TPE had recurrent disease compared 9/15 (60%) patients who received ≥ 3 TPE treatments (p =0.62). Of the 11 patients with FSGS recurrence, 10 (90%) achieved remission within a median of 9 months (range 1 – 24 mos). 8/11 patients received rituximab, 9/11 were switched from tacrolimus to cyclosporine, and all patients remained on TPE until remission was achieved. 5 patients experienced early remission (<3 months) whereas 6 had late (> 3 months) or no remission. Of 5 patients with early remission 100% switched to cyclosporine within 5 days of recurrent disease, compared to only 1/6 (17%) patients with late or no remission (p=0.015). 4/5 patients with early remission received rituximab compared to 4/6 patients with late remission (p=1).

Conclusion

Preemptive TPE does not prevent FSGS recurrence regardless of the number of treatments. Rapid switch to cyclosporine was associated with faster time to remission.