Abstract: TH-PO621
Plasma Exchange and Rituximab for Prevention of Recurrent FSGS after Previous Graft Loss
Session Information
- Membranous Nephropathy, FSGS, and Minimal Change Disease
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Gharaei, Sophie, The University of Manchester Faculty of Biology Medicine and Health, Manchester, United Kingdom
- Kanigicherla, Durga Anil K, Manchester Royal Infirmary, Manchester, United Kingdom
- Abbas, Hashim, Manchester Royal Infirmary, Manchester, United Kingdom
Background
Primary focal segmental glomerulosclerosis (FSGS) commonly recurs after transplantation, significantly increasing the risk of graft dysfunction, especially in patients with prior graft loss due to recurrent FSGS (rFSGS). Even though therapeutic plasma exchange and rituximab have found increasing use in the treatment of post-transplant recurrence, there is no clear consensus on pre-transplant interventions to prevent recurrence in this patient cohort.
Methods
We conducted a systematic review on the role of prophylactic use of rituximab and plasma exchange to prevent the recurrence of FSGS in patients with prior graft loss due to rFSGS. We analysed the outcomes of 32 patients who had a diagnosis of primary FSGS in their native kidneys, lost one or two prior transplants due to recurrence of FSGS, and received prophylactic treatment with plasma exchange, rituximab or a combination of both.
Results
Table 1 summarises the recurrence rates after different prophylactic treatments, encompassing 32 patients across 11 studies with prior graft loss and re-recurrence. Plasma exchange in isolation (62.5%) was the more common intervention used in these patients, rituximab was used in combination in 25%, and in isolation in 12.5% of patients. Recurrence rates were similar across the three interventions. Overall, 47% experienced recurrence, either immediately or within the first three months after transplantation. 53% remained free of FSGS in the index transplant, with a minimum follow-up of 8 months.
Conclusion
Pre-transplant measures may have a role in the prevention of recurrence of post-transplant FSGS in high-risk patients. The paucity of reliable data available in the literature calls for larger prospective controlled studies to further investigate the effectiveness of pre-emptive plasma exchange and rituximab in preventing this devastating complication in patients with rFSGS.
| Prophylaxis (n) | Recurrence (%) | No Recurrence (%) |
| PE only (20) | 9 (45) | 11 (55) |
| RTX only (4) | 1 (25) | 3 (75) |
| PE + RTX (8) | 5 (63) | 3 (37) |
| Total (32) | 15 (47) | 17 (53) |
Table 1. Rates of rFSGS following prophylactic use of plasma exchange (PE) or rituximab (RTX).