Kidney Week

Abstract: PUB224

LDL Apheresis in Recurrent FSGS After Kidney Transplantation in Adults

Session Information

• Publication Only

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Nguyen, Matthew Duy Thanh Luyen, Keck Medicine of USC, Los Angeles, California, United States

Matthew Duy Thanh Luyen Nguyen, MD, MBA

• Duong, Heidi, Keck Medicine of USC, Los Angeles, California, United States

Heidi Duong, DO

• Su, Lauren, Keck Medicine of USC, Los Angeles, California, United States

Lauren Su, MD

• Voora, Santhi, Keck Medicine of USC, Los Angeles, California, United States

Santhi Voora, MD

Background

LDL apheresis (LDL-A) is a promising treatment for recurrent focal segmental glomerulosclerosis (rFSGS) post kidney transplant. We present two cases treated with LDL-A who achieved sustained proteinuria remission (<0.3 g/day).

Methods

We retrospectively reviewed two adults with rFSGS. Both received thymoglobulin and standard triple immunosuppression. After standard treatment for rFSGS, they were treated with LDL-A (biweekly for week 1-3 and weekly for week 6-12) and prednisone (1mg/kg) at week 4. Response was categorized as complete (UPCR ≤0.3 g/day), partial (0.3–3.5 g/day), or no remission (>3.5 g/day).

Results

Case #1 is a 38-year-old Jehovah’s Witness male with renal failure due to biopsy-proven FSGS. Post-transplant, he had immediate graft function but developed renal failure due to rFSGS. He was treated with rituximab and plasmapheresis complicated by recurrent perinephric hematoma. He achieved clinical remission, but due to risk for bleeding with plasmapheresis, LDL-A was started, leading to sustained remission of proteinuria. (Table #1)

Case #2 is a 49-year-old male with rFSGS after living related kidney transplant. On post-operative day 3, he developed nephrotic range proteinuria. He was empirically treated with 15 sessions of plasmapheresis and rituximab with partial response. Kidney biopsy confirmed rFSGS. Due to persistent proteinuria, LDL-A was started with sustained remission of proteinuria. (Figure #1)

Conclusion

We present two cases with sustained remission of proteinuria in post-transplant rFSGS treated with LDL apheresis.