Individualized scheme of immunoadsorption for the recurrence of idiopathic focal segmental glomerulosclerosis in the graft: a single center experience

Figures & data

Table 1. Characteristics of the kidney transplant recipients with idiopathic FSGS as primary disease.

Patient	Gender	Age KTx	HD (months)	Donor source	Donor age (years)	HLA mismatch
1	M	53	165	DD	24	3
2	F	18	12	LRD	45	2
3	M	28	69	DD	51	1
4	M	16	9	DD	39	4
5	F	42	3	LRD	62	4
6	M	53	76	DD	55	3
7	M	31	38	LRD	54	2
8	M	24	30	LRD	45	3
9	M	27	39	LRD	51	2
10	M	18	5	LRD	48	3
11	F	35	113	DD	NA	3
12	M	25	NA	LRD	NA	NA
13^a	F	32	2	LRD	52	2
14^a	M	34	9	LRD	60	3
15^a	F	12	21	DD	39	NA
16^a	M	35	12	LRD	35	1
17^a	M	28	6	LRD	65	1
18^a	M	46	17	DD	NA	3

Notes: DD, deceased donor; HLA, human leukocyte antigen; HD, hemodialysis duration; LRD, living related donor; M, male, F, female; NA, not available; KTx, kidney transplantation.

^aPatient without FSGS recurrence.

Table 2. Course of FSGS recurrence in the graft following treatment with IA.

Patient	Time to recurrence (months)	Peak proteinuria at recurrence (g/day)	Time to remission (months)	Proteinuria at remission (g/day)	Ser. creatinine month 12 (mg/dl)	Final outcome	Total IA sessions	Follow-up (months)
1	0.5	23	3	3.0	1.4	FUN	49	92
2^a	1	8.4	3	0.5	1.0	FUN	239	106
3	1	3.2	4	0.4	1.9	FUN	18	38
4^a	0.5	9.9	1	0.2	1.9	FUN	23	52
5	1	10.4	3	3.2	1.8	ESRD	61	33
6	1	6.1	3	0.2	1.5	FUN	16	13
7	0.5	3.15	1	0.5	2.3	FUN	15	18
8	0.5	16.6	2	0.4	6.3	ESRD	11	16
9	1	5.2	6	1.9	1.5	FUN	20	86
10	1	3.6	2	0.5	2.9	FUN	93	30
11^a	0.5	7.5	2	3.2	1.7	ESRD	225	64
12^a	0.5	10.500	1	3.3	2.0	ESRD	222	50
Mean ± SD	0.75 ± 0.3	8.9 ± 5.9	2.6 ± 1.4	1.4 ± 1.4	2.0 ± 1.0		83	48.3

Notes: ESRD, end-stage renal disease; FUN, functioning graft; IA, immunoadsorption; SD, standard deviation, IA plus rituximab.

Figure 1. Time course of mean 24-h proteinuria (g/day) in patients with FSGS recurrence in the graft following treatment with IA.

Figure 2. Serum creatinine (mg/dl) alterations from the time of FSGS recurrence to the end of follow-up.

Table 3. Rate of FSGS recurrence in the graft among kidney transplant recipients, who received or not IA pre-operatively.

	Patients with recurrent FSGS versus total	Recurrence rate
Preventive IA
Pre-KTx IA+	4/8	50%
Pre-KTx IA–	8/10	80%
Donor type
Living donor	7/11	63.6%
Deceased donor	5/7	71.4%

Figure 3. Time course of 24-h proteinuria (g/day), serum albumin and renal function for one of the four patients who received rituximab in addition to IA. He progressed to ESRD.

Figure 4. Time course of 24-h proteinuria (g/day), serum albumin (g/dl) and serum creatinine (mg/dl) for one of the four patients who received rituximab in addition to IA. Renal function remained stable while proteinuria went into remission.