Individualized scheme of immunoadsorption for the recurrence of idiopathic focal segmental glomerulosclerosis in the graft: a single center experience

Autor:	Sophia Lionaki, Argyrios Georgalis, George Zavos, John Boletis, George Liapis, George Vlachopanos, Chrysanthi Skalioti
Rok vydání:	2015
Předmět:	Adult Male medicine.medical_specialty Adolescent Idiopathic Focal Segmental Glomerulosclerosis urologic and male genital diseases Critical Care and Intensive Care Medicine Single Center Young Adult Recurrence medicine Humans Child Immunoadsorption Kidney transplantation Proteinuria Glomerulosclerosis Focal Segmental business.industry Remission Induction Plasmapheresis General Medicine Middle Aged medicine.disease Kidney Transplantation Tissue Donors female genital diseases and pregnancy complications Surgery Discontinuation Nephrology Renal transplant Renal allograft Kidney Failure Chronic Female medicine.symptom Rituximab business Immunosuppressive Agents
Zdroj:	Renal Failure. 37:777-783
ISSN:	1525-6049 0886-022X
DOI:	10.3109/0886022x.2015.1015366
Popis:	To explore the role of immunoadsorption (IA) for the treatment of idiopathic focal segmental glomerulosclerosis (FSGS) recurrence in the renal allograft, if applied in a personalized manner.We studied patients with end-stage renal disease (ESRD) due to idiopathic FSGS, transplanted between 2001 and 2010. Patients with FSGS recurrence were treated with daily sessions of IA for the first week, followed by an every other day scheme and then individualized tapering until discontinuation. Complete remission was defined as a reduction of 24-h proteinuria to ≤ 0.5 g/day and partial remission as a reduction of 24-h proteinuria to 50% or more from baseline.Of the 18 renal transplant recipients with ESRD due to idiopathic FSGS, 12 (66.7%) experienced disease recurrence in a mean time of 0.75 months post-transplantation (KTx), with a mean proteinuria of 8.9 g/day at the time of recurrence. The mean recipient age was 30.8 years; the mean donor age was 47.4 years, while living related donors provided the allograft in seven cases. Four of the patients received therapy with rituximab in addition to IA. During a mean time of follow-up of 48.3 months, seven patients (58.3%) achieved complete remission, and five (41.7%) partial remission. At the end of follow-up, eight patients (66.7%) had functioning grafts, being in sustained remission, in contrast to four patients (33.3%), who ended up in ESRD because of FSGS recurrence.IA was shown efficacious in a small series of patients with recurrent FSGS in the graft. Renal function remained stable in eight of the 12 patients with FSGS recurrence.
Databáze:	OpenAIRE
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