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Early use of plasmapheresis for recurrent post-transplant FSGS

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Abstract

Recurrence of focal segmental glomerulosclerosis (FSGS) in an allograft is a challenging clinical situation because it frequently results in graft loss. We report our experience with early use of plasmapheresis in recurrent FSGS. Of the 18 (33%) children with biopsy-proven FSGS (in their native kidneys) transplanted at our institution, 6 had recurrence (elevated urine protein/creatinine ratios) post transplant and were treated with plasmapheresis. Patients who received treatment within 1 day of the recurrence (4/6) went into remission after 5–13 plasmapheresis treatments, within 5–27 days of starting treatment. Patients who did not respond to plasmapheresis (2/6) were treated 7 and 17 days after onset of proteinuria; 1 of these had acute tubular necrosis and acute rejection leading to graft loss and the other developed acute rejections, ongoing proteinuria, and subsequent graft loss. All 4 patients who went into remission have maintained good graft function, 22–53 months post transplant. In our experience early institution of plasmapheresis for recurrent post-transplant proteinuria in FSGS is effective.

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Acknowledgements

Part of this work was presented at the Second Congress of the International Pediatric Transplant Association and published in abstract form in Pediatr Transplant 7 [Suppl 4]:64, 2003.

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Authors and Affiliations

  1. Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA

    Madhura Pradhan, Julie Petro, Joanne Palmer, Kevin Meyers & H. Jorge Baluarte

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  1. Madhura Pradhan
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  2. Julie Petro
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  3. Joanne Palmer
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Correspondence to Madhura Pradhan.

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Pradhan, M., Petro, J., Palmer, J. et al. Early use of plasmapheresis for recurrent post-transplant FSGS. Pediatr Nephrol 18, 934–938 (2003). https://doi.org/10.1007/s00467-003-1208-z

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  • DOI: https://doi.org/10.1007/s00467-003-1208-z

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