Rituximab or plasmapheresis for prevention of recurrent focal segmental glomerulosclerosis after kidney transplantation: A systematic review and meta-analysis

Table 2 Characteristics of included studies evaluating the outcomes of preemptive rituximab

Ref.	Country	Design	n (%)	Population	Age	Rituximab dose and protocol	Concurrent PP	Def of recurrence	Recurrence	Graft survival	Follow-up duration	Quality assessment
Burke et al[22], 2009	United States	Retrospective	29	FSGS undergoing KT	Age at KT: 6-21 yr	N/A	No	New onset proteinuria	6/18 (33%) vs 8/11 (72%)	No significant difference in graft survival	N/A	Fair, 3-1-2
Sagheshima et al[23], 2010	United States	Prospective	40	FSGS undergoing KT	Age at KT: 4-24 yr	N/A	No	UPCR > 3.5 post-transplant	8/29 (28%) vs 7/11 (64%)	N/A	N/A	Low, 3-1-1
Fornoni et al[24], 2011	United States	Retrospective	41	High-risk pediatric/young adult FSGS undergoing KT: (< 25 yr at FSGS Dx or progression to ESKD within 7 yr)	Age at KT: 15 ± 5.5 yr (rituximab), 12.3 ± 5.2 yr (control)	One dose of rituximab (375 mg/m2) within 24 h of kidney transplantation	No	UPCR > 3.5 within 30 d post-transplant or need for PP. Protocol biopsy in 20/27 (74%)	7/27 (26%) vs 9/14 (64%)	1-yr graft survival: 95.8% vs 85.7% (P = 0.26)	N/A	High, 4-1-3
Miyauchi et al[25], 2011	Japan	Prospective	25	FSGS undergoing KT	N/A	N/A	N/A	N/A	2/12 (17%) vs 5/13 (38%)	N/A	N/A	Low, 3-1-1
Park et al[26], 2014	South Korea	Retrospective	27	FSGS undergoing KT	Age at KT: 39 ± 14 yr (n = 7, recurrence), 36 ± 11 yr (n = 20, no recurrence)	PP and IVGV infusion after each session of PP prior to transplantation, and RTX (375 mg/m2) was administeredwithin 1 wk prior to transplantation	Yes	Clinical confirmed by biopsy	1/4 (25%) vs 5/18 (27%)	FSGS with recurrence had less graft survival than those without recurrence (P = 0.01)	N/A	High, 4-1-3
Okumi et al[27], 2015	Japan	Retrospective	38	FSGS undergoing KT	N/A	N/A	Yes	N/A	5/23 (22%) vs 6/15 (40%)	5/38 graft loss overall. Cr at yr 2 and 6 significantly lower in those who received both R + PP	N/A	Low, 3-1-1
Futamura et al[28], 2016	Japan	Retrospective	28	FSGS undergoing KT	N/A	N/A	Yes	N/A	3/7 (43%) vs 5/21 (24%)	N/A	N/A	Low, 3-1-1
Alasfar et al[29], 2018	United States	Prospective	64	High-risk FSGS undergoing KT (2 of: white, age ≤ 30 at Dx, progression to ESKD ≤ 5 yr. Albumin < 3 g/dL during disease course, h/o failed KT due to recurrence)	Age at FSGS Dx: 29.9 ± 17.2. Age at KT: 38 ± 16.5	Rituximab was given in 1 or 2 doses (375 mg/m2per dose)	Yes; 3-10 sessions of PP day-7 to POD 2	Clinical and biopsy	23/37 (62%) vs 14/27 (51%)	Trend toward better renal allograft survival in nonrecurrent group comparedto the recurrent group (P = 0.0662)	29.5 mo	High, 4-1-3
Lu et al[30], 2018	United States	Retrospective	55	High-risk FSGS undergoing KT considered (age ≤ 25 at Dx, proteinuria ≥ 5 g/d, progression to ESKD ≤ 5-7 yr)	Age at KT: 44	One dose of rituximab (375 mg/m2, max 100 mg)	No	Proteinuria and biopsy	4/7 (57%) vs 6/48 (13%)	Graft loss: 1/7 (14%) vs 8/48 (17%)	N/A	Fair, 3-2-2
Auñón et al[31], 2021	Spain	Retrospective, multicenter	34 (93 total cohort)	High-risk FSGS undergoing KT considered (hypoalbuminemia and NS at baseline); genetic form excluded	Age at KT: 35.0 ± 15.2 (R group), 42.4 ± 12.2 (non-R group)	Rituximab, 1 g at induction and 1 g on day 14 after transplantation	No	Recurrence of proteinuria, confirmed by biopsy	6/12 (50%) vs 9/22 (41%)	53.5% with recurrence vs 88.5% in non-recurrence group	N/A	High, 4-1-3
Mukku et al[39], 2021	United States	Retrospective	18	FSGS undergoing KT	Age at KT: 35 yr	N/A	Yes	Recurrence of proteinuria	0/8 vs 3/10 (30%)	8/8 vs 9/10	30 (1-36) mo	Low, 3-1-1

N: Number; ESKD: End-stage kidney disease; FSGS: Focal segmental glomerulosclerosis; PP: Plasmapheresis; KT: Kidney transplantation; RTX: Rituximab; N/A: Not available.