Abstract: TH-PO0915
Successful Treatment of Recurrent FSGS in Pediatric Kidney Transplant Patients
Session Information
- Transplantation: Clinical - Glomerular Diseases, Infections, and Rejection
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Victor, Corinna K, LSU Health New Orleans, New Orleans, Louisiana, United States
- Aviles, Diego H., LSU Health New Orleans, New Orleans, Louisiana, United States
- Tulla, Kiara A, Tulane University School of Medicine, New Orleans, Louisiana, United States
- Vehaskari, V. Matti, LSU Health New Orleans, New Orleans, Louisiana, United States
- Straatmann, Caroline E., LSU Health New Orleans, New Orleans, Louisiana, United States
Background
We examined the efficacy of early initiation of prolonged plasmapheresis (PP) in pediatric transplant recipients with recurrent FSGS.
Methods
This is a retrospective review of our center's 41 patients who underwent kidney transplantation for FSGS between 1995 and 2024. Recurrent FSGS in the graft was defined by progressive postoperative increase in proteinuria.
Results
19 of 41 patients (46%) had FSGS recurrence. Of those who recurred, 8 received a graft from a living donor. 10 had bilateral nephrectomies prior to transplant. All patients received standard steroid-based immunosuppression. The average time to recurrence was 2.7 days (ranging from 1 to 9 days), excluding one patient who recurred 28 days after transplant. In the patients who recurred immediately postoperatively, time to initiation of PP ranged from postoperative day 2 to 15. Peak urine protein to creatinine ratio (UPCR) prior to starting PP ranged from 1.7 to 207 mg/mg. All patients received PP daily for 4 to 66 days and were gradually weaned off by increasing PP intervals, guided by daily morning UPCR. PP was discontinued when UPCR was consistently less than 0.5 mg/mg. The total course of PP for all 19 patients ranged from 4 to 37 weeks. Eight patients also received additional immunosuppressive agents. 17 of 19 patients (89%) achieved complete remission. Two patients did not respond and had graft loss. Two patients with the shortest initial course of PP (less than 6 weeks) had a second FSGS recurrence within weeks of discontinuing PP and both remitted again after an additional 3 to 6 weeks of PP. Median observation period was 4.4 years (1.8 to 17 years). All patients maintained complete remission for the duration of pediatric follow up. One patient currently has ESRD secondary to severe transplant rejection, but UPCR remains less than 1 mg/mg. The remaining patients have recent serum creatinine ranging from 0.7 to 3.9 mg/dL and UPCR 0.07 to 0.9 mg/mg, except for one patient with UPCR of 3.2 mg/mg due to chronic allograft nephropathy.
Conclusion
PP was successful in achieving full remission of FSGS recurrence in almost 90% of our patients over the last three decades. Early diagnosis of recurrence, early initiation of PP, and an intensive and prolonged course of PP may be key factors to successful treatment and prevention of graft loss.