Renal Transplantation for Children with Focal Segmental Glomerulosclerosis : Combination Therapy of Plasma Exchange and Pharmacotherapy

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  • 巣状分節性糸球体硬化症(FSGS)の腎移植 : 血漿交換療法(PE)と薬物治療とのコンビネーション(<特集>小児疾患とアフェレシス)

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Focal segmental glomerulosclerosis (FSGS) recurs in 30-40% of transplanted kidneys and the risk of recurrence with a second graft in patients who lost a first graft because of recurrence may approach 100%. Recurrence of FSGS negatively impacts allograft survival. Thus, post-transplantation recurrence of FSGS remains a major clinical issue in the field of renal transplantation. In this article, we review the efficacy and safety of treatments for FSGS recurrence, especially focusing on 1) plasma exchange, 2) rituximab, and 3) combination therapy of plasma exchange and rituximab. A recent review described plasma exchange as effective in inducing partial or complete remission of proteinuria in 70% of children with recurrent FSGS. The other systematic review of FSGS recurrence treated with rituximab showed that complete or partial remission occurred in 64% of patients. Some reports indicated that the combined use of plasma exchange and rituximab may strengthen the efficacy of each treatment. However, the potential side-effects of rituximab have to be kept in mind and closely monitored. Long-term multicenter studies are needed to elucidate the efficacy and adverse effects of rituximab for therapy in children with recurrent FSGS.

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