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Rituximab for Recurrence of Primary Focal Segmental Glomerulosclerosis After Kidney Transplantation: Clinical Outcomes

Garrouste, Cyril MD; Canaud, Guillaume MD, PhD; Büchler, Mathias MD, PhD; Rivalan, Joseph MD; Colosio, Charlotte MD; Martinez, Frank MD; Aniort, Julien MD; Dudreuilh, Caroline MD; Pereira, Bruno PhD; Caillard, Sophie MD, PhD; Philipponnet, Carole MD; Anglicheau, Dany MD, PhD; Heng, Anne Elisabeth MD, PhD

doi: 10.1097/TP.0000000000001160
Original Clinical Science-General

Background: Rituximab has shown encouraging results for the treatment of kidney transplantation recipients with focal segmental glomerulosclerosis (FSGS) recurrence. However, the correct, opportune, and safe use of rituximab for this indication remains to be determined.

Methods: This multicenter retrospective study reports on 19 new cases aged 35 (15-66) years who developed FSGS recurrence at 12 (1.5-27) days posttransplantation. Initial treatment consisted of plasma exchanges (PE), high doses of calcineurin inhibitors, and steroids. Rituximab was introduced either immediately (N = 6) or after failure of the initial treatment (N = 10) or failed attempted weaning from PE (N = 3).

Results: Overall, we observed 9 of 19 complete remissions and 3 of 19 partial remissions. Estimated glomerular filtration rates (Modification of Diet in Renal Disease 4) were significantly higher in the responding patients than in nonresponding patients at month (M)12, M36, and M60. Overall, kidney survival at 5 years was 77.4% (95% range, 41.9-92.7). The 5-year graft survival rates in the responding patients and the nonresponding patients were 100% and 36.5%, respectively (P = 0.01). A further course of rituximab was required for 4 patients as a result of FSGS relapse, with good results. During the first year after renal transplantation, 14 patients developed severe infections (16 bacterial, 4 viral, 1 parasitic).

Conclusions: In kidney transplantation recipients with recurrent FSGS, rituximab therapy may be a recommended treatment for cases that have failed either the initial treatment or weaning from PE.

In this French retrospective study, the authors report on the positive role of rituximab to treat FSGS recurrence following kidney transplantation either in case of failure of initial treatment or in case of relapses.

1 Clermont-Ferrand University Hospital, Department of Nephrology, Clermont-Ferrand, France.

2 Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.

3 Paris Descartes, Sorbonne Paris Cité University, Paris, France.

4 Centaure Foundation and Labex Transplantex, Necker Hospital, Paris, France.

5 CHRU and FHU Transplantation, Department of Nephrology and Clinical Immunology, Tours, France.

6 EA 4245 Dendritic Cells, Immunomodulation and Grafts, François Rabelais University, Tours, France.

7 CHU Pontchaillou, Department of Nephrology, Rennes, France.

8 Department of Nephrology, Hôpital Maison Blanche-CHU Reims, Reims, France.

9 Biostatistics Unit (DRCI), University Hospital Clermont-Ferrand, Clermont-Ferrand, France.

10 University Hospital, Nephrology-Transplantation Department, Strasbourg, France.

11 Université Clermont 1, Clermont-Ferrand, France.

Received 6 October 2015. Revision received 15 January 2016.

Accepted 22 January 2016.

The authors declare no funding or conflicts of interest.

C.G. contributed to the research design, to the analysis of the research data and to the drafting of the present article. G.C. contributed to the research and to the use of new reagents and analytic tools. M.B. contributed to the research work. J.R. contributed to the research work. C.C. contributed to the research work. F.M. contributed to the research work. J.A. contributed to the research work. C.D. contributed to the research work. B.P. contributed to the use of new reagents and analytic tools and to the data analysis. S.C. contributed to the research work. C.P. contributed to the research work. D.A. contributed to the research work and data analysis. A.E.H. contributed to the research design, to the research work, and to the drafting of the present article.

D.A. and A.E.H. contributed equally as cosenior authors.

Correspondence: Cyril Garrouste, CHU Clermont-Ferrand, Service de Néphrologie, CHU Gabriel Montpied, 58 Rue Montalembert, 63003 Clermont-Ferrand, France. (cgarrouste@chu-clermontferrand.fr).

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