Combination of High-Dose Intravenous Cyclosporine and Plasma Exchange Treatment Is Effective in Post-Transplant Recurrent Focal Segmental Glomerulosclerosis: Results of Case Series

Transplant Proc. 2020 Apr;52(3):843-849. doi: 10.1016/j.transproceed.2020.01.024. Epub 2020 Mar 19.

Abstract

Background: Idiopathic focal segmental glomerulosclerosis (FSGS) commonly recurs in the early post-transplant period. The treatment protocols and results are conflictive in recurrent FSGS. We aimed to present the results of our treatment protocol and basic approach to the disease recurrences.

Methods: This prospective, single-center study was conducted between the years 2015 and 2018. Twelve patients who fit completely the diagnosis of idiopathic FSGS by clinical, laboratory, and biopsy findings were included. A specific treatment protocol which consists of plasma exchange and high dose intravenous cyclosporine was delivered to the patients independently of induction protocols. Twenty-four months of outcomes of graft functions were evaluated.

Results: Nine patients completed the treatment protocol and were documented for evaluation. All patients achieved a complete or partial remission in an average 24 months of follow-up period.

Conclusion: Idiopathic FSGS is more commonly recurrent than thought to be. The early detection of proteinuria is crucial because the administration of a plasma exchange-based treatment protocol can reverse proteinuria. We think our treatment protocol is a well-established, efficient, and safe choice for post-transplant recurrent FSGS in adults.

Publication types

  • Evaluation Study

MeSH terms

  • Administration, Intravenous
  • Adult
  • Combined Modality Therapy
  • Cyclosporine / administration & dosage*
  • Female
  • Glomerulosclerosis, Focal Segmental / etiology
  • Glomerulosclerosis, Focal Segmental / therapy*
  • Humans
  • Kidney Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Plasma Exchange / methods*
  • Postoperative Complications / etiology
  • Postoperative Complications / therapy*
  • Prospective Studies
  • Proteinuria / etiology
  • Recurrence
  • Treatment Outcome

Substances

  • Cyclosporine