34 Chronic Immunoadsorption/Plasma Exchange in Patients With Recurrence of Focal Segmental Glomerular Sclerosis After Kidney Transplantation

Abstract

Background Recurrence of focal segmental glomerular sclerosis (FSGS) in a transplanted kidney can lead to graft failure. Membrane plasma exchange (PE) and immunoadsorption (IA) have been reported to be sometimes successful in preventing of FSGS recurrence in transplanted kidneys. The aim of the study is to evaluate the effect of chronic PE/IA on graft function in two transplanted patients with recurrence of FSGS in transplanted kidney.Methods A man, 45 years old, with biopsy proven FSGS in native kidneys was transplanted in January 2001. Soon after transplantation, recurrence of FSGS in transplanted kidney was observed and therefore several cycles of IA therapy were performed after transplantation. Since August 2001 he began chronic IA therapy every 3 weeks. Fresenius‐Excorim membrane plasma exchange monitor with PF 2000 plasmafilter, (Gambro), has been used. One volume of plasma was exchanged per PE. Vascular access was by AV fistula.A woman, 42 years old, with biopsy proven FSGS in native kidneys was transplanted in December 1998. Because of recurrence of FSGS in transplanted kidney she began (after several cycles of IA) with chronic IA in August 2001. Fresenius‐Excorim immunoadsorption monitor was used. One to 2 plasma volumes have been processed per session, and vascular access was by AV fistula.Results Daily proteinuria in the man decreased from 2.27 g in 2001 to 1.13 g in 2004 (50.2% decrease) and serum creatinine increased from 118 µmol/L to 130 µmol/L (9.2% increase).Daily proteinuria in the woman decreased from 3.89 g in 2001 to 2.0 g in 2004 (48% decrease) and serum creatinine increased from 96 µmol/L to 109 µmol/L (12% increase). PE/IA therapy was otherwise uneventful.Conclusions Chronic PE/IA therapy stabilized renal graft function and substantially diminished daily proteinuria. The man lived with kidney graft for more than 3.5 years and woman more than 5.5 years after recurrence of FSGS occurred.