Effect of Post-transplant Double Filtration Plasmapheresis on Recurrent Focal and Segmental Glomerulosclerosis in Renal Transplant Recipients


Dr Shigeru Otsubo, Department of Medicine, Kidney Center, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. Email: sotsubo@ims.u-tokyo.ac.jp


Abstract:  In the present study, we reviewed the effect of post-transplant double filtration plasmapheresis (DFPP) on recurrent focal segmental glomerulosclerosis (FSGS) in the transplanted kidney allograft. Sixteen patients with post-transplant recurrent FSGS were enrolled in this study. Out of 16 patients with recurrent FSGS after transplantation, five did not receive DFPP and lost their grafts, while 11 did receive DFPP and four of these patients lost their grafts. Seven patients were able to maintain normal renal function for an average observation period of 57.1 ± 40.7 months (range 7–125 months). In five patients who had a significant reduction in urinary protein after DFPP, the urinary protein level decreased from 26.60 ± 23.05 g/day (range 3.34–62.6 g/day) to 2.95 ± 3.42 g/day (range 0.02–8.64 g/day) and renal function was maintained. The beneficial effects of DFPP on graft outcome were more likely to occur if the patients experienced a marked drop in urinary excretion. Thus, post-transplant DFPP appears to be effective for reducing urinary protein levels and improving long-term graft survival. With the small numbers in this trial, however, none of the findings were statistically significant. We recommend the use of post-transplant DFPP to prevent  the  progression  of recurrent FSGS.