Outcomes in Recurrent Focal Segmental Glomerulosclerosis Post-Kidney Transplantation Treated With Therapeutic Plasma...

Recurrence of focal segmental glomerulosclerosis (FSGS) following kidney transplantation remains a significant cause of allograft loss. Much remains unknown about the efficacy of apheresis treatments and the factors that determine favorable treatment outcomes. This retrospective cohort study involved adult patients with pre-transplant diagnosis of FSGS, who developed recurrent FSGS in the post-transplant period over 6 years, from January 1, 2017, to December 31, 2022. Twenty patients with biopsy-confirmed FSGS who received therapeutic plasma exchange (TPE) as part of their treatment regimen were included. Demographic data, transplant characteristics, procedure details, urine protein levels, and other relevant variables were retrieved. Data was compiled in a Microsoft Excel spreadsheet and analyzed using the Statistical Package for the Social Sciences (SPSS, IBM NY, 2023, version 29). A p-value of less than 0.05 was considered statistically significant. Data from 20 patients encompassing 169 TPE sessions were analyzed. Of these, 15 patients (75%) achieved remission of proteinuria, while 5 (25%) did not. The median time to remission was 6 months, and the median number of TPE was 7 (interquartile range [IQR] = 2-13). There was no significant difference in time to remission between patients with complete and partial remission. Receiving more than five TPE sessions (adjusted odds ratio [AOR] = 1.6 (1.01-2.46); p = 0.02) and having lower baseline proteinuria at treatment initiation (AOR = 1.9 (1.03-8.94); p = 0.01) were independent predictors of remission. The complication rate was 10.7%, with hypocalcemia being the most common, occurring in 5.9% of cases. One mortality was recorded during apheresis, yielding a procedure mortality rate of 0.6%. Initiating treatment at lower levels of proteinuria (i.e., earlier in the course of disease recurrence) appear to enhance the likelihood of remission. Our result suggests that a trial of therapy extending beyond the initial induction phase may be necessary to capture late-responding patients. The procedure was generally well tolerated, with few reversible adverse events. However, vigilant monitoring remains essential for optimal management.