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Therapeutic plasma exchange in recurrent focal segmental glomerulosclerosis following transplantation
Author(s) -
Shariatmadar S.,
Noto T.A.
Publication year - 2002
Publication title -
journal of clinical apheresis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.697
H-Index - 46
eISSN - 1098-1101
pISSN - 0733-2459
DOI - 10.1002/jca.10025
Subject(s) - medicine , transplantation , focal segmental glomerulosclerosis , immunosuppression , proteinuria , surgery , gastroenterology , biopsy , minimal change disease , urology , coagulopathy , kidney
Abstract Focal segmental glomerulosclerosis (FSGS) recurs in 30% of renal allograft transplants with graft loss in half of the cases. A humoral factor may be implicated. We report on the use of therapeutic plasma exchange (TPE) in 11 patients with recurrent FSGS post transplantation. Medical records from 1989–2000 were reviewed for 11 adults transplanted for biopsy proven FSGS. Ten patients developed proteinuria (x: 6.1 g; range: 3–40 g/24 h) within 2 months of transplantation. In 1 patient, proteinuria (4 g) occurred 2 years post transplantation. Biopsy in six patients revealed early recurrent FSGS, while in five, suspected recurrence was based on clinical findings. Each patient received 5–11 TPEs (x: 6) with the COBE Spectra, daily or on alternate days with 2.5–3.5 L 5% albumin as the replacement fluid. In four, FFP was included because of coagulopathy. All received immunosuppression (IS) during and after TPE. A persistent drop in 24 h urine protein (U.P.) was observed in 10/11 patients. Seven had >70% drop in 24 h U.P. following the course of TPE, while three had a reduction of 45–50%. No change occurred in 1 patient. Follow‐up (9 months–5 years) of seven patients has shown a persistent U.P. of <1 g with successful allograft survival. In these patients, TPE appeared effective in early recurrent FSGS. The decrease in U.P. may result from combined TPE and IS. Although the disease is designated in category III by the ASFA, TPE should be considered early when FSGS recurrence is established. J. Clin. Apheresis 17:78–83, 2002. © 2002 Wiley‐Liss, Inc.