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Published on: May 7, 2019
Rituximab therapy prevents focal and segmental glomerulosclerosis recurrence after a second renal transplantation
Vincent Audard1, Nassim Kamar, Dil Sahali
1Service de Néphrologie et Transplantation, Hôpital Henri Mondor, AP-HP, Institut Francilien de recherche en Néphrologie et Transplantation (IFRNT), Paris Est Université Créteil, France.
Abstract:
Preventive treatment of focal and segmental glomerulosclerosis (FSGS) allograft recurrence in high risk recipients having a prior history of graft loss caused by FSGS recurrence is still a challenging question. We retrospectively identified four patients who underwent a second renal transplantation because of recurrent FSGS and who received Rituximab therapy as a prophylactic treatment. Loss of their first allograft was directly related to an early (<3 months) recurrence of FSGS that was either resistant to plasmapheresis therapy in two cases or had escaped to this therapeutic management in the two others. After the second renal transplantation, all patients were free of FSGS recurrence during follow-ups that were between 12 and 54 months long. These preliminary results demonstrate for the first time that Rituximab therapy may constitute an attractive prophylactic option for patients being considered for a second renal transplantation because of recurrent FSGS in their first graft.
Insights
Rituximab may prevent focal and segmental glomerulosclerosis (FSGS) recurrence after a second kidney transplant in high-risk patients. This study suggests Rituximab as a promising prophylactic treatment for FSGS allograft recurrence.
Area of Science:
- Nephrology
- Immunology
- Transplantation
Background:
- Focal and segmental glomerulosclerosis (FSGS) recurrence post-transplant poses a significant risk for graft loss.
- Preventive strategies for FSGS recurrence, especially in high-risk patients undergoing a second transplant, remain challenging.
- Previous graft loss due to early FSGS recurrence necessitates novel prophylactic approaches.
Observation:
- Four patients with a history of FSGS allograft recurrence leading to graft loss underwent a second renal transplantation.
- These patients received Rituximab as a prophylactic treatment before or after their second transplant.
- First allograft loss was attributed to early (<3 months) FSGS recurrence, resistant or escaped to plasmapheresis.
Findings:
- All four patients remained free of FSGS recurrence during follow-up periods ranging from 12 to 54 months post-second transplantation.
- Rituximab therapy was associated with the absence of FSGS recurrence in this cohort.
- This represents the first evidence suggesting Rituximab's prophylactic potential in recurrent FSGS.
Implications:
- Rituximab may offer a viable prophylactic option for patients at high risk of FSGS allograft recurrence.
- Further research is warranted to confirm these preliminary findings and establish optimal protocols.
- This approach could improve outcomes for patients undergoing repeat kidney transplantation for FSGS.
