Early recurrence of focal segmental glomerulosclerosis in kidney transplant recipients: When to consider regifting

Q4 Medicine Transplantation Reports Pub Date : 2023-06-01 DOI:10.1016/j.tpr.2023.100130
Erika L. Wood , Lorna Kwan , Julia E. Burrows , Gurbir Singh , Jeffrey Veale , Erik L Lum
{"title":"Early recurrence of focal segmental glomerulosclerosis in kidney transplant recipients: When to consider regifting","authors":"Erika L. Wood ,&nbsp;Lorna Kwan ,&nbsp;Julia E. Burrows ,&nbsp;Gurbir Singh ,&nbsp;Jeffrey Veale ,&nbsp;Erik L Lum","doi":"10.1016/j.tpr.2023.100130","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Long term outcomes in <u>transplant recipients experiencing</u> recurrent focal segmental glomerulosclerosis (FSGS) <u>remains</u> poor. <u>Despite</u> early treatment, more than half lose their graft. The aims of this study were to evaluate treatment patterns, outcomes and to evaluate for predictors of treatment failure in recurrent FSGS.</p></div><div><h3>Methods</h3><p>This was a single center retrospective observational study. Between 1/2014 and 8/2019, 1860 kidney transplantations were performed at UCLA, 100 of which had end stage renal disease due to biopsy-proven FSGS. Comparative statistics were obtained and a multivariate analysis for graft outcomes in patients with recurrence was constructed. The <u>primary</u> outcomes were recurrent FSGS, allograft failure and pheresis dependence.</p></div><div><h3>Results</h3><p>Twenty-six <u>of the 100recipients</u> experienced FSGS recurrence. Patients with recurrence were younger (34.3 vs. 44.9, <em>p</em> = 0.001) and more likely to have had native nephrectomy (27% vs. 3%, <em>p</em> = 0.001). Gender, race, comorbidities, donor type, previous transplants and rates of rejection were similar between the recurrence and non-recurrence groups. Most patients received plasmapheresis (<em>n</em> = 24) with or without rituximab (11 vs. 13) which allowed for recovery of graft function in 18 patients (75%). Those experiencing a complete recovery required a median of 9 pheresis sessions, while those with graft failure (<em>n</em> = 3) or who became plasmapheresis-dependent (<em>n</em> = 5) required a median of 59 and 158 sessions, respectively. A multivariate analysis was constructed and no additional predictors of graft failure were encountered.</p></div><div><h3>Conclusions</h3><p>Patients with recurrent FSGS <u>whoexperienced remissiondid so following</u> a short course of plasmapheresis. The patients whose recurrence never resolved or who lost their graft underwent much longer courses of plasmapheresis. If this pattern of early durable response is validated in larger studies, there may be a future when transplant teams discuss the possibility of re-gifting based on <u>treatment response to</u> plasmapheresis following recurrence.</p></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"8 2","pages":"Article 100130"},"PeriodicalIF":0.0000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplantation Reports","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2451959623000057","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0

Abstract

Background

Long term outcomes in transplant recipients experiencing recurrent focal segmental glomerulosclerosis (FSGS) remains poor. Despite early treatment, more than half lose their graft. The aims of this study were to evaluate treatment patterns, outcomes and to evaluate for predictors of treatment failure in recurrent FSGS.

Methods

This was a single center retrospective observational study. Between 1/2014 and 8/2019, 1860 kidney transplantations were performed at UCLA, 100 of which had end stage renal disease due to biopsy-proven FSGS. Comparative statistics were obtained and a multivariate analysis for graft outcomes in patients with recurrence was constructed. The primary outcomes were recurrent FSGS, allograft failure and pheresis dependence.

Results

Twenty-six of the 100recipients experienced FSGS recurrence. Patients with recurrence were younger (34.3 vs. 44.9, p = 0.001) and more likely to have had native nephrectomy (27% vs. 3%, p = 0.001). Gender, race, comorbidities, donor type, previous transplants and rates of rejection were similar between the recurrence and non-recurrence groups. Most patients received plasmapheresis (n = 24) with or without rituximab (11 vs. 13) which allowed for recovery of graft function in 18 patients (75%). Those experiencing a complete recovery required a median of 9 pheresis sessions, while those with graft failure (n = 3) or who became plasmapheresis-dependent (n = 5) required a median of 59 and 158 sessions, respectively. A multivariate analysis was constructed and no additional predictors of graft failure were encountered.

Conclusions

Patients with recurrent FSGS whoexperienced remissiondid so following a short course of plasmapheresis. The patients whose recurrence never resolved or who lost their graft underwent much longer courses of plasmapheresis. If this pattern of early durable response is validated in larger studies, there may be a future when transplant teams discuss the possibility of re-gifting based on treatment response to plasmapheresis following recurrence.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
肾移植受者局灶节段性肾小球硬化的早期复发:何时考虑再移植
背景复发性局灶节段性肾小球硬化(FSGS)的移植受者的长期预后仍然较差。尽管早期治疗,仍有一半以上的移植物脱落。本研究的目的是评估复发性FSGS的治疗模式、结果和治疗失败的预测因素。方法本研究是一项单中心回顾性观察性研究。2014年1月至2019年8月,加州大学洛杉矶分校共进行了1860例肾移植,其中100例因活检证实的FSGS而患有终末期肾病。获得了比较统计数据,并对复发患者的移植物结果进行了多变量分析。主要转归为复发性FSGS、移植物移植失败和外周血运依赖。结果100例受试者中有26例发生FSGS复发。复发患者更年轻(34.3 vs.44.9,p=0.001),更有可能进行自体肾切除术(27%vs.3%,p=0.001。复发组和非复发组的性别、种族、合并症、供体类型、既往移植和排斥反应率相似。大多数患者接受了血浆置换术(n=24),无论是否使用利妥昔单抗(11对13),这允许18名患者(75%)恢复移植物功能。那些经历完全康复的患者平均需要9次血浆置换,而那些移植失败的患者(n=3)或血浆置换依赖性患者(n=5)平均分别需要59次和158次。构建了一个多变量分析,没有发现移植失败的额外预测因素。结论复发性FSGS患者在短期血浆置换后出现缓解。复发从未消退或失去移植物的患者接受了更长的血浆置换疗程。如果这种早期持久反应模式在更大规模的研究中得到验证,那么移植团队可能会在未来根据复发后血浆置换的治疗反应来讨论重新给予的可能性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
Transplantation Reports
Transplantation Reports Medicine-Transplantation
CiteScore
0.60
自引率
0.00%
发文量
24
审稿时长
101 days
期刊介绍: To provide to national and regional audiences experiences unique to them or confirming of broader concepts originating in large controlled trials. All aspects of organ, tissue and cell transplantation clinically and experimentally. Transplantation Reports will provide in-depth representation of emerging preclinical, impactful and clinical experiences. -Original basic or clinical science articles that represent initial limited experiences as preliminary reports. -Clinical trials of therapies previously well documented in large trials but now tested in limited, special, ethnic or clinically unique patient populations. -Case studies that confirm prior reports but have occurred in patients displaying unique clinical characteristics such as ethnicities or rarely associated co-morbidities. Transplantation Reports offers these benefits: -Fast and fair peer review -Rapid, article-based publication -Unrivalled visibility and exposure for your research -Immediate, free and permanent access to your paper on Science Direct -Immediately citable using the article DOI
期刊最新文献
Management challenges in primary hyperoxaluria type 1 with end-stage kidney disease: A case report Report on living liver donor risk and outcomes: Single center experience A national survey of immunosuppression adjustment in elderly lung transplant recipients Combined lung and liver transplant for cirrhosis, idiopathic pulmonary fibrosis, and hemophilia A: Case report Implementing a standardized workflow for early detection of steroid-induced hyperglycemia in allogeneic stem cell transplant recipients: A quality improvement project
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1