Rituximab for recurrence of primary focal segmental glomerulosclerosis after kidney transplantation: Results of a nationwide study.

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 2021 Sep

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Rituximab (RTX) therapy for primary focal segmental glomerulosclerosis recurrence after kidney transplantation (KT) has been extensively debated. We aimed to assess the benefit of adding RTX to plasmapheresis (PP), corticosteroids, and calcineurin inhibitors (standard of care, SOC). We identified 148 adult patients who received KT in 12/2004-12/2018 at 21 French centers: 109 received SOC (Group 1, G1), and 39 received immediate RTX along with SOC (Group 2, G2). In G1, RTX was introduced after 28 days of SOC in the event of failure (G1a, n = 19) or PP withdrawal (G1b, n = 12). Complete remission (CR) was achieved in 46.6% of patients, and partial remission (PR) was achieved in 33.1%. The 10-year graft survival rates were 64.7% and 17.9% in responders and nonresponders, respectively. Propensity score analysis showed no difference in CR+PR rates between G1 (82.6%) and G2 (71.8%) (p = .08). Following the addition of RTX (G1a), 26.3% of patients had CR, and 31.6% had PR. The incidence of severe infections was similar between patients treated with and without RTX. In multivariable analysis, infection episodes were associated with hypogammaglobulinemia <5 g/L. RTX could be used in cases of SOC failure or remission for early discontinuation of PP without increasing the risk of infection. © 2021 The American Society of Transplantation and the American Society of Transplant Surgeons.

Citation

Camille Lanaret, Dany Anglicheau, Vincent Audard, Mathias Büchler, Sophie Caillard, Lionel Couzi, Paolo Malvezzi, Laurent Mesnard, Dominique Bertrand, Franck Martinez, Vincent Pernin, Didier Ducloux, Coralie Poulain, Antoine Thierry, Arnaud Del Bello, Jean P Rerolle, Clarisse Greze, Charlotte Uro-Coste, Julien Aniort, Céline Lambert, Nicolas Bouvier, Betoul Schvartz, Nicolas Maillard, Johnny Sayegh, Julie Oniszczuk, Marie-Pascale Morin, Christophe Legendre, Nassim Kamar, Anne E Heng, Cyril Garrouste. Rituximab for recurrence of primary focal segmental glomerulosclerosis after kidney transplantation: Results of a nationwide study. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2021 Sep;21(9):3021-3033