Review of plasma exchange and rituximab for prevention of recurrent focal segmental glomerulosclerosis after a prior graft loss.
Gharaei, S., et al.World Journal of Transplantation 2024; 14(4): 98155.
Aims
This study aimed to investigate whether plasma exchange and rituximab were effective in preventing recurrent focal segmental glomerulosclerosis (FSGS) in kidney transplant recipients following a prior graft loss.
Interventions
The PubMed and Scopus databases were searched for relevant studies. Studies were screened for eligibility by two independent reviewers.
Participants
11 studies were included in the review.
Outcomes
The main outcomes were re-recurrence rates and treatment after re-recurrence.
Follow-up
N/A
CET Conclusions
This paper reports a systematic review in renal transplantation, assessing the impact of prophylactic plasma exchange and rituximab in the prevention of recurrent FSGS. The population was restricted to patients with primary FSGS who had previously lost a transplant to recurrent FSGS and were undergoing another renal transplant. The search identified a small number of papers (68), which was then narrowed down to 11 papers after assessing all the inclusion and exclusion criteria. The number of included patients was small (n=38). There was no quality assessment presented in the paper, and no indication of duplicate searching or data extraction. Whilst the rituximab doses were consistent, the application of plasma exchange was highly variable, with between 3 and 17 sessions undertaken. The recurrence rate of FSGS was still very high despite the use of either rituximab, plasma exchange, or both in prophylaxis (47% recurrence at median follow up 8 months). This paper does not support the use of prophylactic rituximab or plasma exchange in the prevention of re-recurrent FSGS after renal transplantation, and did not present data on the potential complications of these therapies.
Trial registration
N/A