Open AccessDouble recurrence of FSGS after two renal transplants with complete regression after plasmapheresis and ACE inhibitors
Author(s) -
Montagnino Giuseppe,
Tarantino Antonio,
Banfi Giovanni,
Maccario Massimo,
Costamagna Laura,
Ponticelli Claudio
Publication year - 2000
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/j.1432-2277.2000.tb01059.x
Subject(s) - plasmapheresis , medicine , transplantation , kidney transplantation , urology , surgery , biopsy , nephrology , glomerulosclerosis , cadaveric spasm , focal segmental glomerulosclerosis , kidney , glomerulonephritis , proteinuria , immunology , antibody
A patient who had undergone a first cadaveric donor kidney transplantation for idiopathic focal segmental glomerular sclerosis (FSGS), had an immediate recurrence of a biopsy‐proven FSGS that eventually led to graft failure within 5 years from transplantation. The patient underwent a second cadaveric transplantation 10 months later. An immediate recurrence of a biopsy‐proven FSGS occurred that was treated with two protracted cycles of plasmapheresis of seven months each, with the addition of an ACE inhibitor from the beginning. A complete and stable remission of FSGS was observed, which continues after more than 6 years from the end of plasmapheresis. The recurrence of FSGS after a second transplantation has a poor prognosis, but prolonged plasmapheresis treatment, by removing circulating factors altering glomerular permselectivity, and the addition of ACE inhibitors, through their potential interference with TGF‐β, might be synergistic in obtaining permanent remission.