Koutroutsos Konstantinos, Charif Rawya, Moran Linda, Moss Jill, Cook Terence, Roufosse Candice, Pusey Charles, Taube David, Loucaidou Marina
Imperial College Kidney and Transplant Centre, London, UK.
Sussex Kidney Unit, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK.
Clin Exp Nephrol. 2019 May;23(5):700-709. doi: 10.1007/s10157-019-01690-0. Epub 2019 Jan 14.
Post-transplant focal segmental glomerulosclerosis (FSGS) is associated with renal allograft loss. Currently, optimal treatment remains controversial.
The aim of our study was to examine the efficacy and safety of therapeutic plasma exchange (TPE), and rituximab (RTX), in the management of post-transplant FSGS. The treatment protocol consisted of RTX and monthly cycles of 5 plasma exchanges for 6 months. We treated 10 transplant recipients with biopsy-proven post-transplant FSGS. Lastly, we compared the studied group to a historic control group of nine patients with post-transplant FSGS.
9 out of 10 patients achieved remission after the conclusion of treatment (4 complete and 5 partial), while 1 patient did not respond to treatment. During the follow-up period, there was one graft loss and one patient died while in remission from unrelated complications. There was a significant reduction in mean uPCR between diagnosis (517.4 ± 524.2 mg/mmol) and last follow-up (87 ± 121.6 mg/mmol) in the patients with sustained remission (p = 0.026). There was no significant decline in eGFR in the eight relapse-free responders at the end of follow-up. (54.4 ± 16.7 from 49.8 ± 20.4 ml/min) (p = 0.6) An increased response rate to the combined TPE and RTX treatment was demonstrated, when compared to a historic control group of nine patients with post-transplant FSGS, as only five out of nine patients achieved remission (two complete and three partial) in that group.
In this study, treatment with TPE and RTX appears to be safe, well tolerated and effective in the management of patients with post-transplant FSGS.
移植后局灶节段性肾小球硬化（FSGS）与肾移植失败相关。目前，最佳治疗方案仍存在争议。
本研究旨在探讨治疗性血浆置换（TPE）和利妥昔单抗（RTX）治疗移植后FSGS的疗效和安全性。治疗方案包括RTX及每月进行5次血浆置换，共6个月。我们对10例经活检证实为移植后FSGS的受者进行了治疗。最后，我们将研究组与9例移植后FSGS患者的历史对照组进行了比较。
10例患者中有9例在治疗结束后达到缓解（4例完全缓解，5例部分缓解），1例患者对治疗无反应。在随访期间，有1例移植失败，1例患者在缓解期因无关并发症死亡。持续缓解的患者从诊断时（517.4±524.2mg/mmol）到最后一次随访时（87±121.6mg/mmol），平均尿蛋白肌酐比值显著降低（p=0.026）。随访结束时，8例无复发的缓解者的估算肾小球滤过率无显著下降（从49.8±20.4ml/min降至54.4±16.7ml/min）（p=0.6）。与9例移植后FSGS患者的历史对照组相比，联合TPE和RTX治疗的反应率有所提高，该组9例患者中只有5例达到缓解（2例完全缓解，3例部分缓解）。
在本研究中，TPE和RTX治疗移植后FSGS患者似乎是安全、耐受性良好且有效的。
