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Pre-emptive rituximab and plasma exchange does not prevent disease recurrence following living donor renal transplantation in high-risk idiopathic SRNS

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Pre-emptive rituximab and plasma exchange does not prevent disease recurrence following living donor renal transplantation in high-risk idiopathic SRNS

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Mohan Shenoy, Rachel Lennon, Nick Plant, Dean Wallace & Amrit Kaur 

Abstract

Background

Children with non-genetic steroid-resistant nephrotic syndrome (SRNS) are at high risk of disease recurrence (DR) and graft loss following renal transplant (RT). Although pre-emptive plasma exchange (PE) and rituximab have been suggested to prevent DR, there is insufficient published data to support this practice. The aim is to study the role of pre-emptive PE and rituximab in the prevention of DR in children with non-genetic SRNS undergoing living donor (LD) RT.

Methods

Prospective single-centre study of four consecutive children (age 6–17 years) with non-genetic SRNS (including two with previous graft loss due to DR) who underwent LD RT between July 2014 and September 2016. All patients received a single dose of rituximab 375 mg/m2 2–4 weeks prior to the RT and four sessions of PE in the week prior to RT. All patients had previously undergone bilateral native nephrectomies.

Results

All children had early DR (2–26 days) following LD RT. Following early initiation of PE, three children achieved partial remission (PR) or complete remission (CR) 5–22 days after commencing treatment. One child continued to have heavy proteinuria along with graft dysfunction despite 52 sessions of PE and lost the graft 5 months after RT. At the latest follow-up of 36–60 months following RT, one child remains in CR and two are in PR. The latest eGFR was 45–104 ml/min/1.73m2.

Conclusions

Pre-emptive rituximab and PE does not prevent DR in high-risk non-genetic SRNS. Prompt initiation of PE following DR appears to achieve PR or CR in the majority of patients.

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Year 2020
Language English
Format PDF
DOI 10.1007/s00467-020-04500-y