Rituximab for Recurrence of Primary Focal Segmental Glomerulosclerosis After Kidney Transplantation: Clinical Outcomes
Rituximab for Recurrence of Primary Focal Segmental Glomerulosclerosis After Kidney Transplantation: Clinical Outcomes
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DOI：
10.1097/tp.0000000000001160
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发表时间：
2017-03-01
期刊：
影响因子：
6.2
通讯作者：
Heng, Anne Elisabeth
中科院分区：
文献类型：
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作者：
Garrouste, Cyril;Canaud, Guillaume;Heng, Anne Elisabeth
利妥昔单抗在治疗肾移植受者局灶节段性肾小球硬化（FSGS）复发方面显示出令人鼓舞的结果。然而，正确、适时和安全的使用利妥昔单抗治疗这一适应症仍有待确定。方法对19例35岁（15-66）岁的FSGS移植术后12（1.5-27）天复发的新病例进行多中心回顾性研究。最初的治疗包括血浆交换（PE），高剂量钙调磷酸酶抑制剂和类固醇。立即（N = 6）或在初始治疗失败（N = 10）或尝试从PE断奶失败（N = 3）后引入利妥昔单抗。结果19例患者中有9例完全缓解，3例部分缓解。在第12个月、第36个月和第60个月，应答患者的肾小球滤过率（肾病患者饮食改变4）明显高于无应答患者。总体而言，5年肾脏存活率为77.4%（95%范围，41.9-92.7）。缓解组5年生存率为100%，无缓解组5年生存率为36.5% （P = 0.01）。由于FSGS复发，4例患者需要进一步的利妥昔单抗治疗，效果良好。肾移植术后1年内发生严重感染14例（细菌性感染16例，病毒性感染4例，寄生虫感染1例）。结论：对于复发性FSGS的肾移植受者，对于初始治疗失败或从PE中断奶的病例，利妥昔单抗治疗可能是一种推荐治疗方法。
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.