Plasmapheresis treatment for recurrent focal sclerosis in pediatric renal allografts

Recurrence of focal segmental glomerulosclerosis (FSGS) in pediatric renal allografts is associated with a poor graft survival. This study reports on plasmapheresis for the treatment of recurrent FSGS in pediatric renal trans plant recipients. The records of 100 consecutive pediatric (age <21 years) renal transplants were reviewed. Twenty patients had FSGS as the cause of r enal failure. Eight of these (40%) had a recurrence (proteinuria >1 g/m(2) per day) within 1 month of transplantation. Five of six patients treated wi th plasmapheresis went into remission (<0.2 g/m(2) per day), receiving a to tal of 42+/-26 (12-73) sessions, with the mean number of sessions required to achieve a remission being 24+/-17 (8-51). One patient had a second recur rence 1 year following cessation of plasmapheresis and responded to another course of plasmapheresis. The 1 patient who did not respond to plasmaphere sis had a delay in initiation of therapy of 42 days. Plasmapheresis initiat ed within 48 h of recurrence resulted in earlier remissions and improved gr aft survival among our patients. Plasmapheresis appears to be effective in treating recurrent FSGS following kidney transplantation and should be star ted as soon as possible. The number of plasmapheresis sessions used to achi eve remission should be adjusted according to response rather than adhering to a fixed protocol.