Treatment of Recurrent Focal Segmental Glomerulosclerosis in Pediatric Kidney Transplant Recipients : Effect of Rituximab

Abstract EN

Recurrence of focal segmental glomerulosclerosis (FSGS) after renal transplantation is a complication that often leads to graft loss.

There is no consensus on the optimal treatment of recurrent FSGS.

Rituximab, a monoclonal antibody to CD20, may be a useful treatment of this complication.

Methods.

We report four pediatric cases of recurrent FSGS treated with rituximab and plasmapheresis.

Results.

Four children (2M/2F), age 15.3 ± 2.6, with recurrent FSGS posttransplant were identified.

Four doses of rituximab were administered 171 ± 180 days posttransplant and 114 ± 169 days after the start of plasmapheresis.

Three children responded with complete remission, one of whom relapsed after four months.

One child had a partial response with a decrease in proteinuria that was not sustained.

No adverse side effects were reported during treatment or followup (mean 22.5 months).

Conclusions.

Rituximab is a safe and well-tolerated ancillary treatment for recurrent FSGS in pediatric patients in conjunction with plasmapheresis.