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Kidney Week

Abstract: PO2569

Case Study of Repository Corticotropin Injection (RCI) Prophylaxis for FSGS Recurrence in Kidney Transplant

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Venkataraman, Sandheep, University of Colorado, Denver, Colorado, United States
  • Crowther, Barrett R., University of Colorado, Denver, Colorado, United States
  • Grafals, Monica, University of Colorado, Denver, Colorado, United States
Introduction

Idiopathic FSGS recurs post-transplant in one third of cases and is associated with a five-fold higher risk of graft loss1.

Case Description

In this single center pilot case study, 8 patients with biopsy-proven FSGS were treated with RCI prophylaxis 80 units subcutaneously twice a week for 6 months from day of kidney Tx, compared with a group of 6 patients who were treated with RCI later after the diagnosis of FSGS recurrence.

Discussion

All patients received rATG as induction and were on standard immunosuppression with FK, MMF, and prednisone. Patients in the control group were diagnosed with recurrent FSGS between 5-63 days post Tx. There where 3 patients in the study group that developed recurrent FSGS, 2 of them required plex. Patient 1 in the study group had DGF after a live donor kidney Tx from recurrent FSGS. Her protocol biopsy performed one year after transplant and still shows foot process effacement but no fibrosis or sclerosis in light microscopy. All but one patient in the control group have still functioning allografts.

Conclusions: This is a small pilot study, but its findings suggest that use of RCI at time of kidney transplant surgery in patients with FSGS decreases the severity of the disease with less fibrosis in follow up biopsies despite the presence of foot process effacement. There may also be a decreased need for plex in the study group, however, further studies are needed to confirm this

 Sex (M=male, F=female)Race (C=Caucasian, AA=African-American, H=Hispanic)Average Proteinuria at 3 months Post Transplant (mg/mg)
Study Group (n=8)3 F, 5 M5 C, 1 AA, 2 H0.925
Comparison Group (n=6)6 M3 C, 3 H4.486

Patient 1 in study group, 1 week after live donor kidney transplant.

Patient 1 in study group, one year post transplant.