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The effect of peri-transplant plasmapheresis in the prevention of recurrent FSGS

P S Verghese1, M N Rheault1, S Jackson2

  • 1Department of Pediatrics, Division of Pediatric Nephrology, University of Minnesota, Minneapolis, MN, USA.

Pediatric Transplantation
|February 2, 2018
PubMed

Insights

Preemptive plasmapheresis did not significantly reduce Focal Segmental Glomerulosclerosis (FSGS) recurrence after pediatric kidney transplants. This study suggests re-evaluating the role of plasmapheresis in preventing FSGS recurrence.

Area of Science:

  • Nephrology
  • Pediatric Transplant Surgery
  • Immunology

Background:

  • Focal Segmental Glomerulosclerosis (FSGS) recurrence post-kidney transplant is a significant concern in pediatric cases.
  • Preemptive plasmapheresis is utilized by many centers to prevent FSGS recurrence, but its effectiveness remains uncertain.
  • This study investigates the impact of a specific plasmapheresis protocol on FSGS recurrence rates in pediatric kidney transplant recipients.

Purpose of the Study:

  • To evaluate the effectiveness of preemptive plasmapheresis in preventing FSGS recurrence after pediatric kidney transplantation.
  • To compare transplant and patient outcomes between pediatric FSGS patients who received plasmapheresis and those who did not.

Main Methods:

  • Retrospective review of 57 pediatric FSGS cases undergoing kidney transplantation.
  • Comparison of outcomes for patients transplanted after 2006 (with plasmapheresis) versus before 2006 (without plasmapheresis).
  • Analysis of FSGS recurrence incidence and time to recurrence in both cohorts.

Main Results:

  • No significant difference in FSGS recurrence incidence (27% vs. 26%, P=1.0) between groups.
  • No significant difference in the time to FSGS recurrence in the kidney allograft (P=0.22).
  • Significant differences in cohort characteristics including age and immunosuppression protocols were noted.

Conclusions:

  • Preemptive plasmapheresis did not demonstrate a significant benefit in preventing FSGS recurrence in this pediatric cohort.
  • The findings suggest a need to re-evaluate the role and efficacy of preemptive plasmapheresis protocols.
  • A prospective, multicenter study is recommended to further investigate the role of plasmapheresis in preventing FSGS recurrence.

Keywords:
end-stage renal diseasefocal segmental glomerulosclerosiskidney transplantpediatric kidney transplantationpediatricsrecurrence

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