Rituximab does not Prevent Focal and Segmental Glomerulosclerosis Recurrence after Renal Transplantation in Patients at Risk

Background/Aims: We present a case of a male patient with severe recurrence of focal and segmental glomerulosclerosis (FSGS) after transplant. Methods: Before the transplant he was treated with plasma exchange. Massive proteinuria was detected post-transplantation and plasma exchanges were performed without response. We administered 5 doses of Rituximab (375 mg/m2) and partial remission was achieved. Proteinuria relapse occurred 1 year post-transplant, so Immunoadsorption (IA) was started instead of plasma exchange with reduction of proteinuria. Later, 2 new episodes of proteinuria relapse were detected and treated by increasing the number of IA sessions and administering new cycles of Rituximab. After achieving partial remission, IA was reduced to one session every 7–10 days as maintenance therapy. Results: Despite the fact of the severe recurrence, renal function and proteinuria remain stable over 8 years after the transplantation was performed. Conclusion: Combination of maintenance IA and cycles of Rituximab is an effective treatment for aggressive forms of FSGS recurrence after renal transplantation.

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Rituximab therapy prevents focal and segmental glomerulosclerosis recurrence after a second renal transplantation

Transplant International ◽

10.1111/j.1432-2277.2012.01462.x ◽

2012 ◽

Vol 25 (5) ◽

pp. e62-e66 ◽

Cited By ~ 30

Author(s):

Vincent Audard ◽

Nassim Kamar ◽

Dil Sahali ◽

Isabelle Cardeau-Desangles ◽

Sébastien Homs ◽

...

Keyword(s):

Renal Transplantation ◽

Focal And Segmental Glomerulosclerosis ◽

Segmental Glomerulosclerosis

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Non-Invasive Cardiac Investigations in Patients Awaiting Renal Transplantation

Journal of the Royal Society of Medicine ◽

10.1177/014107689709000306 ◽

1997 ◽

Vol 90 (3) ◽

pp. 136-137 ◽

Cited By ~ 5

Author(s):

E J Langford ◽

A J De Belder ◽

H Cairns ◽

B M Hendry ◽

R J Wainwright

Keyword(s):

At Risk ◽

Renal Transplantation ◽

Cardiac Death ◽

Systolic Function ◽

Left Ventricular ◽

Exercise Electrocardiography ◽

Lv Dysfunction ◽

Patients At Risk ◽

Artery Disease ◽

Lv Systolic Function

Patients with chronic renal failure undergoing renal transplantation have a high prevalence of cardiovascular disease. Invasive investigation may identify those at risk of cardiac death during or after renal transplantation, but which patients should undergo cardiac catheterization is currently not clear. In 95 patients awaiting renal transplantation we assessed the ability of echocardiography and exercise electrocardiography to identify patients at risk of cardiac death. Echocardiography identified impaired left ventricular (LV) systolic function in 20%, severe in 8%. Of the patients with severe LV dysfunction, 25% died before transplantation. Of those undergoing exercise electrocardiography, 44% did not achieve 85% of maximum predicted heart rate. No coronary artery disease requiring intervention was identified by exercise testing. These findings indicate that echocardiography, but not exercise electrocardiography, should be part of the assessment for renal transplantation.

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Pre-emptive rituximab in focal and segmental glomerulosclerosis patients at risk of recurrence after kidney transplantation

Clinical Kidney Journal ◽

10.1093/ckj/sfz120 ◽

2019 ◽

Author(s):

Pilar Auñón ◽

Natalia Polanco ◽

María José Pérez-Sáez ◽

Emilio Rodrigo ◽

Asunción Sancho ◽

...

Keyword(s):

At Risk ◽

Nephrotic Syndrome ◽

Kidney Transplantation ◽

Disease Onset ◽

Significant Risk ◽

Significant Risk Factor ◽

Risk Of Recurrence ◽

Segmental Glomerulosclerosis ◽

Diagnosis Rate ◽

Patients At Risk

Abstract Background The recurrence of proteinuria after kidney transplantation (KT) is a characteristic complication of focal segmental glomerulosclerosis (FSGS). It has been suggested that pre-emptive rituximab might prevent recurrences in patients at risk, but there is no agreement about which factors might help to identify such patients. Methods We studied 93 kidney transplants with biopsy-proven idiopathic FSGS in order to analyse if preventive rituximab treatment could decrease recurrences in patients at risk. Results Fifteen patients (16.1%) presented a recurrence after KT, but when we restricted the analysis to the 34 patients presenting nephrotic syndrome at primary disease onset, the recurrence diagnosis rate increased to 44.1%. All patients with recurrence had complete nephrotic syndrome at the time of diagnosis. After multivariate adjustment, the only significant risk factor for recurrence was the presence of complete nephrotic syndrome at diagnosis. Twelve of the 34 patients at risk for recurrence received rituximab at the time of transplantation. Clinical and analytical characteristics were similar in all patients at risk. The number of recurrences was similar among treated (50%) and non-treated patients (40.9%). Conclusions Nephrotic syndrome with hypoalbuminaemia at diagnosis is the most important feature to identify patients at risk of recurrence. Our data suggest that pre-emptive rituximab is not effective to prevent FSGS recurrences.

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