Preventing FSGS with Preemptive Plasmapheresis

Austin, Texas—Approximately 30% to 50% of recipients of renal transplants experience recurrence of focal segmental glomerulosclerosis (FSGS). This recurrence is associated with poor prognosis, and can lead to loss of graft and subsequent return to dialysis. FSGS recurrence can occur as early as a matter of hours post-transplant or as late as years after transplant.

Increased risk for FSGS recurrence is associated with younger age, rapid progression to end-stage renal disease (ESRD) from diagnosis, non-African race, heavy proteinuria prior to transplantation, and FSGS recurrence as the reason for previous graft loss. Patient and allograft outcomes can be improved with prevention of recurrence of FSGS.

Ann K. Gamilla-Crudo, MD, and colleagues at the University of Texas Medical Branch (UTMB) Galveston presented case reports of three patients who underwent preemptive plasmapheresis. The cases were described during a poster session at the NKF 2018 Spring Clinical Meetings in a poster titled Preemptive Plasmapheresis for Prevention of Post-Transplant FSGS Recurrence: UTMB Experience.

The patients had a history of clinically aggressive FSGS that was biopsy proven with rapid progression to ESRD. The first patient had biopsy proven FGSG and required dialysis within a year; the other two had known FSGS and lost their previous graft to recurrence of FSGS. All three patients underwent preemptive  plasmapheresis prior to transplantation and had two other sessions post-operatively on days 2 and 4 following transplant.

On post-operative day 5, rituximab 375 mg/m2 was given intravenously. Thymoglobulin was given for induction. Immunosuppression therapy included prednisone, mycophenolic acid, and tacrolimus. During hospitalization, urine protein to creatinine ratios were obtained daily; during outpatient clinic visits, urine protein to creatinine ratios were obtained twice weekly. As of the time of the poster session, all three patients had “excellent kidney function with no proteinuria.”

“In a select group of patients, our preemptive protocol for prevention of FSGS recurrence appears to be successful in maintaining excellent graft function,” the authors said.

Source: Gamilla-Crudo AK, Lal Y, Chaudhary V, Ramirez R, Mujtaba M. Preemptive plasmapheresis for prevention of post-transplant FSGS recurrence: UTMB experience. Abstract of a poster presented during the National Kidney Foundation 2018 Spring Clinical Meetings, April 10-14, 2018, Austin, Texas.