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Published on: May 2, 2013
Multiple-target Therapy for Posttransplant Focal Segmental Glomerulosclerosis
Juliana Mansur1,2, Domingo Chang-Dávila3, Marcela Giraldes Simões1,2
1Nephrology Division, Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil.
Background:
There is no consensus on the ideal strategy to treat posttransplant focal segmental glomerulosclerosis. The multiple-target therapy, which consisted of high-dose intravenous cyclosporine, prednisone, and plasmapheresis, showed favorable results.
Methods:
This single-center, prospective study sought to evaluate the multiple-target therapy in an independent cohort of patients.
Results:
Thirteen patients with posttransplant focal segmental glomerulosclerosis received multiple-target therapy. Complete remission was achieved in 2 patients (15.4%), and partial remission in another 2 patients (15.4%). Four patients (30.7%) did not show remission, and 5 patients (38%) lost the graft because of posttransplant focal segmental glomerulosclerosis during the 12-mo follow-up. Premature discontinuation of treatment occurred in 10 patients (77%), all associated with infectious adverse events. Cytomegalovirus was the most common complication, and preemptive therapy was used instead of prophylaxis.
Conclusions:
In this cohort of patients, the efficacy of the multiple-target therapy was poor and limited by the high incidence of infectious adverse events.
