Response to plasma exchange and graft survival in recurrent focal and segmental glomerulosclerosis after transplantation: does the time of recurrence matter? A retrospective study

Summary Recurrence of primary focal and segmental glomerulosclerosis following kidney transplantation (rFSGS) is a frequent and severe disease. We studied the time to recurrence of FSGS and its impact on the response to plasma exchange (PE) and graft survival. Between 1990 and 2013, 2730 kidney tran...

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Published in:Transplant international 2021-02, Vol.34 (2), p.302-312
Main Authors: Dudreuilh, Caroline, Barbet, Christelle, Gatault, Philippe, Ferlicot, Sophie, Lebranchu, Yvon, Rabot, Nolwenn, Beaudreuil, Severine, Dürrbach, Antoine, Büchler, Matthias
Format: Article
Language:English
Subjects:
Apheresis
Exchanging
Kidney transplantation
Kidney transplants
plasma exchange
primary focal and segmental glomerulosclerosis
recurrence
Remission
Survival
Transplants
Transplants & implants
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Summary:Summary Recurrence of primary focal and segmental glomerulosclerosis following kidney transplantation (rFSGS) is a frequent and severe disease. We studied the time to recurrence of FSGS and its impact on the response to plasma exchange (PE) and graft survival. Between 1990 and 2013, 2730 kidney transplants were performed, including 52 patients with a primary diagnosis of FSGS. Of these patients with primary FSGS, 34 (67%) developed rFSGS. We retrospectively divided these patients into two groups depending on the time to recurrence: early (up to three months after transplantation, n = 26) or late (more than three months after transplantation, n = 8). Survival did not significantly differ between the two groups. In cases of late recurrence, PE was started later and was performed less frequently, and remission was achieved after more PE sessions and longer PE treatment than for the early group (P = 0.01). In early recurrence, resistance to PE at 40 days was associated with no long‐term response to PE. PE should be performed as soon as possible after rFSGS. Patients with late rFSGS need to be offered the same treatment regime as those with early rFSGS.
ISSN:0934-0874
1432-2277
DOI:10.1111/tri.13796