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Intensive and Prolonged Treatment of Focal and Segmental Glomerulosclerosis Recurrence in Adult Kidney Transplant Recipients: A Pilot Study
Author(s) -
Canaud G.,
Zuber J.,
Sberro R.,
Royale V.,
Anglicheau D.,
Snanoudj R.,
Gaha K.,
Thervet E.,
Lefrère F.,
CavazzanaCalvo M.,
Noël L.H.,
Méjean A.,
Legendre Ch.,
Martinez F.
Publication year - 2009
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/j.1600-6143.2009.02580.x
Subject(s) - medicine , focal segmental glomerulosclerosis , proteinuria , transplantation , kidney transplantation , urology , surgery , glomerulosclerosis , kidney , kidney disease , gastroenterology
No treatment has consistently induced long‐term remission of proteinuria in adult patients with focal segmental glomerulosclerosis (FSGS) recurrence after kidney transplantation. We undertook an open‐label, nonrandomized pilot trial of intensive and prolonged treatment of FSGS recurrence. Over an 18‐month period, 10 adult kidney transplant recipients with FSGS recurrence received concomitantly high‐dose steroids, intravenous cyclosporine for 14 days followed by oral cyclosporine therapy, and an intensive and prolonged course of plasma exchanges (PE). We compared this treatment with those of a control group of 19 patients with a FSGS recurrence transplanted between 1997 and 2005. Complete, rapid (mean 23 ± 7 days) and sustained remission was obtained in 9/10 patients (90%) as opposed to 27% in the control group. At month 3 and month 12, proteinuria was 0.16 g/day (range 0.05–0.3 g/day) and 0.19 g/day (range 0.05–1 g/day) respectively. Only one patient remained in partial remission at month 12 but he had already lost two previous grafts due to FSGS recurrence. PEs were stopped at month 9 in all patients except for the patient with a partial remission who remains PE‐dependent. This small pilot study provides very encouraging results demonstrating that this treatment rapidly achieves complete and sustained remission in a high proportion of patients.