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Successful Treatment of Recurrent Focal Segmental Glomerulosclerosis After Transplantation in Children: A
K A Alhasan1, A Alherbish1, A Osman2
1Department of Pediatrics, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia; Organ Transplant Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
Insights
Managing recurrent focal segmental glomerulosclerosis (FSGS) in pediatric kidney transplant patients showed success with rituximab and switching immunosuppressants. This treatment approach, combined with plasmapheresis, proved effective and safe for most young recipients.
Area of Science:
- Nephrology
- Pediatric Transplantation
- Immunosuppression
Background:
- Recurrent focal segmental glomerulosclerosis (FSGS) poses a significant challenge in pediatric renal transplantation.
- Effective management strategies for post-transplant FSGS recurrence are crucial for long-term graft survival.
Purpose of the Study:
- To evaluate the clinical experience and outcomes of managing recurrent FSGS in pediatric kidney transplant recipients.
- To assess the efficacy and safety of different therapeutic interventions, including plasmapheresis, rituximab, abatacept, and immunosuppressant modifications.
Main Methods:
- Retrospective chart review of pediatric patients undergoing their first kidney transplant between 2014 and 2016.
- Analysis of treatment strategies, including plasmapheresis, rituximab, abatacept, and switching from tacrolimus to cyclosporine.
- Evaluation of patient response, adverse events, and overall outcomes.
Main Results:
- Six pediatric patients with recurrent FSGS post-transplant were analyzed.
- Five patients (83.3%) achieved a complete response with treatments including plasmapheresis, rituximab, and/or switching to cyclosporine.
- Treatment was generally well-tolerated, although one patient experienced severe complications and mortality.
Conclusions:
- Rituximab and switching from tacrolimus to cyclosporine, alongside plasmapheresis, demonstrate efficacy and safety in managing pediatric recurrent FSGS.
- Abatacept did not show significant clinical benefit in the cases reviewed.
- These findings support specific immunosuppressive and supportive care strategies for recurrent FSGS in pediatric renal transplant recipients.
Objective:
We aim to report our experience managing cases of recurrent focal segmental glomerulosclerosis (FSGS) in a group of pediatric renal transplant recipients.
Methods:
This study was a retrospective chart review of pediatric patients who had their first kidney transplant at King Faisal Specialist Hospital & Research Center between 2014 and 2016.
Results:
We reviewed the files of 6 patients, 3 of whom were male. The median age of the children was 2.75 years (range, 2-4 years) at disease onset, with an average time of progression to end-stage renal disease of 19 months (range, 8-30 months). Five of the patients received a living related donor transplant, and 1 received a living nonrelated donor transplant. Patients had FSGS recurrence at varying intervals (1 to 3 days) post transplant. All cases had plasmapheresis prior to receiving abatacept or rituximab. The therapeutic strategy in 4 patients involved switching tacrolimus to cyclosporine. A complete response was observed in 5 of the 6 patients (83.3%), and treatment was well tolerated in 5 patients. Patient 1 had severe oliguria and required intermittent hemodialysis during the first 3 weeks post transplant. He showed minimal response to the therapeutic plasma exchange and rituximab and was subsequently treated with abatacept. However, he died 8 months post transplant of pneumonia and sepsis.
Conclusion:
Rituximab and switching tacrolimus to cyclosporine, in conjunction with plasmapheresis, appeared to be effective and safe in children with recurrent FSGS. Conversely, abatacept did not appear to provide clinical benefit.
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