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Rituximab for recurrence of primary focal segmental glomerulosclerosis after kidney transplantation: Results of a nationwide study
Author(s) -
Lanaret Camille,
Anglicheau Dany,
Audard Vincent,
Büchler Mathias,
Caillard Sophie,
Couzi Lionel,
Malvezzi Paolo,
Mesnard Laurent,
Bertrand Dominique,
Martinez Franck,
Pernin Vincent,
Ducloux Didier,
Poulain Coralie,
Thierry Antoine,
Del Bello Arnaud,
Rerolle Jean P.,
Greze Clarisse,
UroCoste Charlotte,
Aniort Julien,
Lambert Céline,
Bouvier Nicolas,
Schvartz Betoul,
Maillard Nicolas,
Sayegh Johnny,
Oniszczuk Julie,
Morin MariePascale,
Legendre Christophe,
Kamar Nassim,
Heng Anne E.,
Garrouste Cyril
Publication year - 2021
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.16504
Subject(s) - medicine , rituximab , discontinuation , focal segmental glomerulosclerosis , hypogammaglobulinemia , calcineurin , transplantation , gastroenterology , plasmapheresis , kidney transplantation , immunosuppression , surgery , kidney , immunology , glomerulonephritis , antibody , lymphoma
Rituximab (RTX) therapy for primary focal segmental glomerulosclerosis recurrence after kidney transplantation (KT) has been extensively debated. We aimed to assess the benefit of adding RTX to plasmapheresis (PP), corticosteroids, and calcineurin inhibitors (standard of care, SOC). We identified 148 adult patients who received KT in 12/2004–12/2018 at 21 French centers: 109 received SOC (Group 1, G1), and 39 received immediate RTX along with SOC (Group 2, G2). In G1, RTX was introduced after 28 days of SOC in the event of failure (G1a, n = 19) or PP withdrawal (G1b, n = 12). Complete remission (CR) was achieved in 46.6% of patients, and partial remission (PR) was achieved in 33.1%. The 10‐year graft survival rates were 64.7% and 17.9% in responders and nonresponders, respectively. Propensity score analysis showed no difference in CR+PR rates between G1 (82.6%) and G2 (71.8%) ( p = .08). Following the addition of RTX (G1a), 26.3% of patients had CR, and 31.6% had PR. The incidence of severe infections was similar between patients treated with and without RTX. In multivariable analysis, infection episodes were associated with hypogammaglobulinemia <5 g/L. RTX could be used in cases of SOC failure or remission for early discontinuation of PP without increasing the risk of infection.