Kidney Week

Abstract: FR-PO1166

LDL Apheresis as a Novel Adjunctive Therapy for Recurrent FSGS After Kidney Transplantation

Session Information

• Transplantation: Clinical - Transplant Access, Recipient Evaluation, Living Donors, Pregnancy, and More
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Karuparti, Haritha, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Haritha Karuparti, MD

• Lakhani, Laila S., The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Laila S. Lakhani, MD

• Eboh, George C., The University of Texas Southwestern Medical Center, Dallas, Texas, United States

George C. Eboh, MD

• Davis, Terra, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Terra Davis, PA-C

• Wojciechowski, David, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

David Wojciechowski, DO

Introduction

Primary FSGS recurs in 30%–60% of kidney transplant recipients and can lead to allograft loss. LDL-A technique utilizing the Liposorber LA-15 system is an FDA-approved treatment for recurrent FSGS that is refractory to standard therapies. We present 3 cases of early recurrent FSGS treated with LDL apheresis showing variable improvement in proteinuria.

Case Description

Case 1: 66-year-old male underwent DDKT for presumed CNI-related ESKD. Biopsy done for proteinuria showed primary FSGS (>80% foot process effacement). Treatment with steroids and PLEX was initiated. After lack of response, LDL-A was initiated. Despite 12 sessions, he remains with nephrotic-range proteinuria with modest improvement at best.
Case 2: 41-year-old male underwent DDKT for presumed hypertensive ESKD. Biopsy for rising creatinine and proteinuria showed Banff 2A rejection and collapsing glomerulopathy (FSGS). Steroids, ATG, and PLEX, resulted in partial response. After 12 LDL-A sessions, proteinuria decreased <50%. He is currently maintained on biweekly LDL-A therapy.
Case 3: 57-year-old female underwent LUKT for CKD V from primary FSGS. Biopsy for proteinuria confirmed recurrent FSGS. Steroids, PLEX, and Rituximab showed partial response. Proteinuria decreased >50% after 12 LDL-A sessions. Given recurrence 6-weeks post-apheresis, she was retreated and currently remains on biweekly LDL-A

Discussion

Standard treatment for primary FSGS recurrence includes steroids, PLEX and Rituximab. However, aggressive variants remain refractory. LDL-A is an adjunctive therapy that removes ApoB-containing lipoproteins, including LDL and VLDL, while preserving HDL and essential plasma proteins. Preliminary data shows LDL-A enhances efficacy of immunosuppressive agents by mitigating hypercholesterolemia-induced receptor dysfunction and improvement in podocytopathy.
Our cases of early-recurrent post-transplant FSGS had variable response to LDL-A. Case 2 and 3 showed notable improvement in proteinuria with minimal fibrosis on biopsy. More data is needed to determine if LDL-A removes the circulating factor in recurrent FSGS, or if it has anti-inflammatory effects.

Response to LDL Aphersis