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Plasmapheresis treatment for recurrent focal sclerosis in pediatric renal allografts

S M Greenstein1, M Delrio, E Ong

  • 1Department of Surgery, Montefiore Medical Center, Bronx, New York 10467, USA. SGreenst@montefiore.org

Pediatric Nephrology (Berlin, Germany)
|October 25, 2000
PubMed

Insights

Plasmapheresis effectively treats recurrent focal segmental glomerulosclerosis (FSGS) in pediatric kidney transplant patients. Early initiation of plasmapheresis improves remission rates and graft survival for FSGS recurrence.

Area of Science:

  • Nephrology
  • Transplantation immunology

Background:

  • Recurrent focal segmental glomerulosclerosis (FSGS) after kidney transplantation significantly impacts graft survival in pediatric recipients.
  • FSGS recurrence affects approximately 40% of pediatric renal allograft recipients within the first month post-transplant.

Purpose of the Study:

  • To evaluate the efficacy of plasmapheresis in treating recurrent FSGS in pediatric renal transplant recipients.
  • To determine the optimal timing and protocol for plasmapheresis in managing post-transplant FSGS recurrence.

Main Methods:

  • Retrospective review of 100 consecutive pediatric renal transplants.
  • Analysis of 20 patients with FSGS as the cause of end-stage renal disease.
  • Assessment of treatment outcomes for 6 patients receiving plasmapheresis for recurrent FSGS.

Main Results:

  • Five of six pediatric patients treated with plasmapheresis achieved remission of FSGS.
  • Early initiation of plasmapheresis (within 48 hours) correlated with faster remissions and better graft survival.
  • One patient with delayed treatment initiation did not respond, while another responded to a second plasmapheresis course after a late recurrence.

Conclusions:

  • Plasmapheresis is an effective treatment for recurrent FSGS in pediatric kidney transplant recipients.
  • Prompt initiation of plasmapheresis is crucial for achieving remission and improving long-term graft outcomes.
  • Treatment protocols should be individualized based on patient response rather than a fixed number of sessions.

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