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Kidney Week

Abstract: PO2568

Rituximab or Plasmapheresis for Prevention of Focal Segmental Glomerulosclerosis Recurrence After Kidney Transplantation: A Meta-Analysis

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Boonpheng, Boonphiphop, University of California Los Angeles, Los Angeles, California, United States
  • Thongprayoon, Charat, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Cheungpasitporn, Wisit, University of Mississippi Medical Center, Jackson, Mississippi, United States
Background

Focal segmental glomerulosclerosis (FSGS) can recur after kidney transplantation. Prevention of FSGS recurrence with rituximab and/or plasmapheresis has been evaluated in multiple small studies with conflicting results. We performed this meta-analysis to assess the post-transplant recurrence risk of FSGS with prophylactic rituximab and/or plasmapheresis in addition to standard immunosuppression.

Methods

A systematic review was conducted in MEDLINE, EMBASE, Cochrane databases from inception through April 2020 to identify studies that evaluated the risks of post-transplant FSGS after rituximab with or without plasmapheresis or plasmapheresis alone compared to controls. Effect estimates from the individual study were extracted and combined using random-effects model.

Results

10 studies with a total of 381 FSGS patients undergoing kidney transplantation evaluated rituximab with or without rituximab and 11 studies with a total of 520 kidney transplant recipients with FSGS evaluated plasmapheresis alone. There was no significant difference in recurrence between the group that received rituximab with or without plasmapheresis and the standard treatment group, with a pooled risk ratio of 0.84 (95% CI, 0.47-1.48, I2= 67%). Plasmapheresis alone was also not associated with any significant difference in FSGS recurrence compared to no plasmapheresis with a pooled risk ratio of 0.94 (95% CI, 0.65-1.37, I2= 20%). Subgroup analysis in the pediatric or adult group did not yield significant recurrence risk difference.

Conclusion

Rituximab with or without plasmapheresis or plasmapheresis alone was not associated with lower risk of FSGS recurrence after kidney transplantation.

Forest plots
(A) preventive rituximab on FSGS recurrence
(B) plasmapheresis on FSGS recurrence