Preoperative low-density lipoprotein apheresis and rituximab for preventing recurrence of focal segmental glomerulosclerosis after kidney transplantation

Abstract

【Objective】 Focal segmental glomerulosclerosis (FSGS) often develops rapidly and frequently progresses to renal failure, while the recurrence rate after kidney transplantation is 20-50%. We performed low-density lipoprotein (LDL) apheresis and administered rituximab before kidney transplantation in FSGS patients to prevent recurrence.

【Design】 Retrospective observational study.

【Methods】 Six adult patients with chronic renal failure due to FSGS undergoing living related donor kidney transplantation were investigated retrospectively. LDL apheresis was done 2 times and a low dose of rituximab was administered before transplantation. Postoperative renal function and recurrence of FSGS were assessed.

【Results】 The patients were four men and two women aged 21 to 40 years. The observation period ranged from 6 to 31 months. Blood LDL cholesterol levels were normal before LDL apheresis, and remained normal both after LDL apheresis and after kidney transplantation. Additional LDL apheresis was performed once in one patient with mild proteinuria after transplantation. The renal graft survived in all patients and there was no evidence of recurrent FSGS.

【Conclusion】 Although the observation period was short, FSGS did not recur in any of the 6 patients receiving preoperative LDL apheresis and rituximab. These results suggest that the combination of LDL apheresis and rituximab can be effective for preventing recurrence of FSGS after kidney transplantation.