Clinical Outcomes of Prophylactic and Therapeutic Plasmapheresis in Adult Deceased-Donor Kidney Transplant Recipients With Primary Focal Segmental Glomerulosclerosis

Mariarosaria Campise, Evaldo Favi, Piergiorgio Messa

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: High recurrence and inferior graft survival rates have been reported for kidney transplant recipients with primary focal segmental glomerulosclerosis. Plasmapheresis is widely used to treat posttransplant relapsing focal segmental glomerulosclerosis, but the effectiveness of prophylactic plasmapheresis remains controversial. MATERIALS AND METHODS: In this single-center retrospective study, 21 adult deceased-donor kidney transplant recipients who received prophylactic plasmapheresis were analyzed. Of these, 10 received posttransplant prophylactic plasmapheresis only (less-intensive regimen) and 11 received pre- and posttransplant prophylactic plasmapheresis (more-intensive regimen). Patients with recurrence were treated with steroids and plasmapheresis. Median follow-up was 45 months (interquartile range, 30-107 mo). RESULTS: At last visit, 20/21 patients (95%) were alive and 17/21 (81%) had functioning grafts. Cumulative focal segmental glomerulosclerosis recurrence rate was 38% (8/21): 30% (3/10) in the less-intensive and 45% (5/11) in the more-intensive group (P = .6594). Four of 8 patients (50%) with relapse eventually had graft loss due to recurrence: 100% (3/3) in the less-intensive and 20% (1/5) in the more-intensive group (P = .1429). Complete remission was observed in 25% (2/8) of recipients with recurrence: 0% (0/3) in the less-intensive and 40% (2/5) in the more-intensive group (P = .4643). Two of 8 patients (25%) remained plasmapheresis dependant: 0% (0/3) in the less-intensive and 40% (2/5) in the more-intensive group (P = .4643). Response rate (complete/partial) was higher in the more-intensive group (80% [4/5] vs 0% [0/3]; P = .1429); however, overall, the 2 regimens did not show significantly different outcomes. Comparison between this series and a historical control group of 52 patients with primary focal segmental glomerulosclerosis transplanted at our center and not receiving plasmapheresis prophylaxis did not demonstrate any advantages. CONCLUSIONS: No benefits from prophylactic plasmapheresis in deceased-donor kidney transplant recipients with primary focal segmental glomerulosclerosis were shown. Prospective randomized studies comparing alternative preemptive strategies are warranted.

Original languageEnglish
Pages (from-to)461-469
Number of pages9
JournalExperimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation
Volume17
Issue number4
DOIs
Publication statusPublished - Aug 1 2019

Fingerprint

Focal Segmental Glomerulosclerosis
Plasmapheresis
Tissue Donors
Kidney
Recurrence
Therapeutics
Transplants
Transplant Recipients
Graft Survival
Survival Rate
Retrospective Studies
Steroids
Prospective Studies
Control Groups

ASJC Scopus subject areas

  • Transplantation

Cite this

@article{2a66d99118d0429c9228728ff9be87fc,
title = "Clinical Outcomes of Prophylactic and Therapeutic Plasmapheresis in Adult Deceased-Donor Kidney Transplant Recipients With Primary Focal Segmental Glomerulosclerosis",
abstract = "OBJECTIVES: High recurrence and inferior graft survival rates have been reported for kidney transplant recipients with primary focal segmental glomerulosclerosis. Plasmapheresis is widely used to treat posttransplant relapsing focal segmental glomerulosclerosis, but the effectiveness of prophylactic plasmapheresis remains controversial. MATERIALS AND METHODS: In this single-center retrospective study, 21 adult deceased-donor kidney transplant recipients who received prophylactic plasmapheresis were analyzed. Of these, 10 received posttransplant prophylactic plasmapheresis only (less-intensive regimen) and 11 received pre- and posttransplant prophylactic plasmapheresis (more-intensive regimen). Patients with recurrence were treated with steroids and plasmapheresis. Median follow-up was 45 months (interquartile range, 30-107 mo). RESULTS: At last visit, 20/21 patients (95{\%}) were alive and 17/21 (81{\%}) had functioning grafts. Cumulative focal segmental glomerulosclerosis recurrence rate was 38{\%} (8/21): 30{\%} (3/10) in the less-intensive and 45{\%} (5/11) in the more-intensive group (P = .6594). Four of 8 patients (50{\%}) with relapse eventually had graft loss due to recurrence: 100{\%} (3/3) in the less-intensive and 20{\%} (1/5) in the more-intensive group (P = .1429). Complete remission was observed in 25{\%} (2/8) of recipients with recurrence: 0{\%} (0/3) in the less-intensive and 40{\%} (2/5) in the more-intensive group (P = .4643). Two of 8 patients (25{\%}) remained plasmapheresis dependant: 0{\%} (0/3) in the less-intensive and 40{\%} (2/5) in the more-intensive group (P = .4643). Response rate (complete/partial) was higher in the more-intensive group (80{\%} [4/5] vs 0{\%} [0/3]; P = .1429); however, overall, the 2 regimens did not show significantly different outcomes. Comparison between this series and a historical control group of 52 patients with primary focal segmental glomerulosclerosis transplanted at our center and not receiving plasmapheresis prophylaxis did not demonstrate any advantages. CONCLUSIONS: No benefits from prophylactic plasmapheresis in deceased-donor kidney transplant recipients with primary focal segmental glomerulosclerosis were shown. Prospective randomized studies comparing alternative preemptive strategies are warranted.",
author = "Mariarosaria Campise and Evaldo Favi and Piergiorgio Messa",
year = "2019",
month = "8",
day = "1",
doi = "10.6002/ect.2018.0106",
language = "English",
volume = "17",
pages = "461--469",
journal = "Current Alzheimer Research",
issn = "1567-2050",
publisher = "Bentham Science Publishers B.V.",
number = "4",

}

TY - JOUR

T1 - Clinical Outcomes of Prophylactic and Therapeutic Plasmapheresis in Adult Deceased-Donor Kidney Transplant Recipients With Primary Focal Segmental Glomerulosclerosis

AU - Campise, Mariarosaria

AU - Favi, Evaldo

AU - Messa, Piergiorgio

PY - 2019/8/1

Y1 - 2019/8/1

N2 - OBJECTIVES: High recurrence and inferior graft survival rates have been reported for kidney transplant recipients with primary focal segmental glomerulosclerosis. Plasmapheresis is widely used to treat posttransplant relapsing focal segmental glomerulosclerosis, but the effectiveness of prophylactic plasmapheresis remains controversial. MATERIALS AND METHODS: In this single-center retrospective study, 21 adult deceased-donor kidney transplant recipients who received prophylactic plasmapheresis were analyzed. Of these, 10 received posttransplant prophylactic plasmapheresis only (less-intensive regimen) and 11 received pre- and posttransplant prophylactic plasmapheresis (more-intensive regimen). Patients with recurrence were treated with steroids and plasmapheresis. Median follow-up was 45 months (interquartile range, 30-107 mo). RESULTS: At last visit, 20/21 patients (95%) were alive and 17/21 (81%) had functioning grafts. Cumulative focal segmental glomerulosclerosis recurrence rate was 38% (8/21): 30% (3/10) in the less-intensive and 45% (5/11) in the more-intensive group (P = .6594). Four of 8 patients (50%) with relapse eventually had graft loss due to recurrence: 100% (3/3) in the less-intensive and 20% (1/5) in the more-intensive group (P = .1429). Complete remission was observed in 25% (2/8) of recipients with recurrence: 0% (0/3) in the less-intensive and 40% (2/5) in the more-intensive group (P = .4643). Two of 8 patients (25%) remained plasmapheresis dependant: 0% (0/3) in the less-intensive and 40% (2/5) in the more-intensive group (P = .4643). Response rate (complete/partial) was higher in the more-intensive group (80% [4/5] vs 0% [0/3]; P = .1429); however, overall, the 2 regimens did not show significantly different outcomes. Comparison between this series and a historical control group of 52 patients with primary focal segmental glomerulosclerosis transplanted at our center and not receiving plasmapheresis prophylaxis did not demonstrate any advantages. CONCLUSIONS: No benefits from prophylactic plasmapheresis in deceased-donor kidney transplant recipients with primary focal segmental glomerulosclerosis were shown. Prospective randomized studies comparing alternative preemptive strategies are warranted.

AB - OBJECTIVES: High recurrence and inferior graft survival rates have been reported for kidney transplant recipients with primary focal segmental glomerulosclerosis. Plasmapheresis is widely used to treat posttransplant relapsing focal segmental glomerulosclerosis, but the effectiveness of prophylactic plasmapheresis remains controversial. MATERIALS AND METHODS: In this single-center retrospective study, 21 adult deceased-donor kidney transplant recipients who received prophylactic plasmapheresis were analyzed. Of these, 10 received posttransplant prophylactic plasmapheresis only (less-intensive regimen) and 11 received pre- and posttransplant prophylactic plasmapheresis (more-intensive regimen). Patients with recurrence were treated with steroids and plasmapheresis. Median follow-up was 45 months (interquartile range, 30-107 mo). RESULTS: At last visit, 20/21 patients (95%) were alive and 17/21 (81%) had functioning grafts. Cumulative focal segmental glomerulosclerosis recurrence rate was 38% (8/21): 30% (3/10) in the less-intensive and 45% (5/11) in the more-intensive group (P = .6594). Four of 8 patients (50%) with relapse eventually had graft loss due to recurrence: 100% (3/3) in the less-intensive and 20% (1/5) in the more-intensive group (P = .1429). Complete remission was observed in 25% (2/8) of recipients with recurrence: 0% (0/3) in the less-intensive and 40% (2/5) in the more-intensive group (P = .4643). Two of 8 patients (25%) remained plasmapheresis dependant: 0% (0/3) in the less-intensive and 40% (2/5) in the more-intensive group (P = .4643). Response rate (complete/partial) was higher in the more-intensive group (80% [4/5] vs 0% [0/3]; P = .1429); however, overall, the 2 regimens did not show significantly different outcomes. Comparison between this series and a historical control group of 52 patients with primary focal segmental glomerulosclerosis transplanted at our center and not receiving plasmapheresis prophylaxis did not demonstrate any advantages. CONCLUSIONS: No benefits from prophylactic plasmapheresis in deceased-donor kidney transplant recipients with primary focal segmental glomerulosclerosis were shown. Prospective randomized studies comparing alternative preemptive strategies are warranted.

UR - http://www.scopus.com/inward/record.url?scp=85071149163&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071149163&partnerID=8YFLogxK

U2 - 10.6002/ect.2018.0106

DO - 10.6002/ect.2018.0106

M3 - Article

VL - 17

SP - 461

EP - 469

JO - Current Alzheimer Research

JF - Current Alzheimer Research

SN - 1567-2050

IS - 4

ER -