Plasmapheresis in Recurrent Focal Segmental Glomerulosclerosis after Renal Transplantation / 대한신장학회잡지

ABSTRACT

Focal segmental glomerulosclerosis (FSGS) in pediatric age tends to progress to end stage renal disease and to recur after renal transplantation. And recurrence of FSGS after kidney transplantation results in the graft loss in above half of cases. An unknown circulating factor in serum and immunologic dysfunction may be responsible for the recurrence. So, plasmapheresis to remove the uncertain serum factor and high dose cyclosporin A to control the immunologic system have been tried as the therapeutic regimen. We experienced 5 patients with recurrent FSGS after transplantation and tried plasmapheresis and methyl prednisolone pulse therapy with high dose cyclosporin A for them. The patients were 2 girls and 3 boys, aged between 8 and 14 years. In all cases, the kidney was donated by living related donors. Recurrence of FSGS was detected by postop. 3 days. Plasmapheresis started within 1 week after recurrence in 4 cases, and 2 months in 1 case. Early plasmapheresis brought rapid and sustained remission in 2 cases without evidence of acute rejection and short-term partial response in remaining 3 cases. In conclusion, plasmapheresis with high dose cyclosporin A resulted in a good outcome in recurrent FSGS. And starting plasmapheresis as early, prior to irreversible glomerular scarring, as possible is important for immediate and long-term prognosis in recurrent FSGS after renal transplantation.