Systematic Reviews
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Dec 18, 2024; 14(4): 98155
Published online Dec 18, 2024. doi: 10.5500/wjt.v14.i4.98155
Review of plasma exchange and rituximab for prevention of recurrent focal segmental glomerulosclerosis after a prior graft loss
Sophie Gharaei, Hashim Abbas, Durga Anil Kanigicherla
Sophie Gharaei, Manchester Medical School, University of Manchester, Manchester M139WL, United Kingdom
Hashim Abbas, Durga Anil Kanigicherla, Department of Renal Medicine, Manchester University NHS Foundation Trust, Manchester M13 9WL, United Kingdom
Author contributions: Kanigicherla DA, Abbas H and Gharaei S decided on research idea and study design; Gharaei S conducted initial literature review, followed by in-depth full article reviews by Gharaei S and Kanigicherla DA; Data was extracted and the report was written by Gharaei S and Kanigicherla DA, with additional review by Abbas H; Supervision and mentorship were provided throughout by Kanigicherla DA and Abbas H.
Conflict-of-interest statement: All authors declared no financial conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Durga Anil Kanigicherla, MD, Doctor, Department of Renal Medicine, Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom. durga.kanigicherla@mft.nhs.uk
Received: June 19, 2024
Revised: July 18, 2024
Accepted: July 24, 2024
Published online: December 18, 2024
Processing time: 93 Days and 3.5 Hours
Abstract
BACKGROUND

Focal segmental glomerulosclerosis (FSGS) often recurs after transplantation, leading to graft dysfunction and graft loss. Patients who have lost prior grafts due to recurrence are at particularly high risk of re-recurrence in subsequent grafts. Rituximab and plasma exchange have been used pre-emptively to prevent post-transplant recurrence. However, the efficacy of such preventative measures remains unclear.

AIM

To investigate the outcomes of preventative rituximab and plasma exchange for recurrent FSGS in transplant recipients after prior graft loss.

METHODS

We conducted a systematic review of 11 studies with 32 patients who had experienced prior graft loss due to post-transplant FSGS recurrence and were treated with either pre-emptive plasma exchange alone, rituximab alone, or a combination of both.

RESULTS

Overall, 47% of the 32 patients experienced recurrence despite prophylactic treatment. Re-recurrence was seen in 25% (1/4) with pre-emptive rituximab alone, and 45% recurrence (9/20) with plasma exchange alone. Re-recurrence was noted in 63% with the use of combined plasma exchange and rituximab.

CONCLUSION

There is a paucity of available evidence in the literature to draw clear conclusions on the benefits of pre-emptive measures to prevent FSGS re-recurrence. The small sample sizes and variations in protocols call for larger and controlled studies to serve this patient population at high risk of recurrence and graft loss.

Keywords: Focal segmental glomerulosclerosis; Glomerular disease; Plasma exchange; Rituximab; Transplantation

Core Tip: Patients with prior graft losses due to post-transplant recurrence of focal segmental glomerulosclerosis are at particularly high risk of re-recurrence in subsequent transplants. With scarcity of transplants and limited options, prevention becomes vital. However, there has been a recommendation against the use of pre-emptive measures to prevent recurrence. Currently, there is too little evidence described in the literature to draw clear conclusions on the efficacy of preventative treatment. This lack of evidence for benefit does not necessarily equate to evidence of lack of benefit. Larger controlled studies are needed to investigate the effectiveness of pre-emptive measures.