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Combined rituximab and plasmapheresis or plasma exchange for focal segmental glomerulosclerosis in adult kidney transplant recipients: a meta-analysis

  • Nephrology - Original Paper
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Abstract

Purpose

To demonstrate the efficacy of combined rituximab and plasmapheresis (PP)/plasma exchange (PE) therapy for focal segmental glomerulosclerosis in transplanted kidneys (ptFSGS).

Methods

We searched MEDLINE, SCOPUS, and Cochrane Library for eligible publications. Only observational studies or clinical trials containing patients’ age > 18 years were included for full-text extraction.

Results

A total of eight observational studies (n = 85) were included in meta-analyses. With a median follow-up of 18 months (IQR 4.4), combination therapy of RTX-PP/PE in patients with ptFSGS resulted in overall remission rate of 72.7% (95% CI 52.3–86.6%) with a significant reduction of proteinuria and serum creatinine levels. Complete remission was 41.0%, while partial remission was 31.7%. The mean difference of serum creatinine levels between pre- and post-treatment was − 0.65 mg/dL (95% CI − 1.15 to − 0.14). The mean difference of the degree of proteinuria between pre- and post-treatment was − 4.79 g/day (95% CI − 7.02 to − 2.56). Subgroup analyses were performed after adjusted for study year, type of intervention, and primary pre-transplant lesion. Patients with recurrent FSGS tended have lesser reduction in the degree of proteinuria compared to patients with de novo FSGS. Incidence of serious adverse events with combined RTX-PP/PE therapy was 0.12 event/year.

Conclusion

We conclude that combined RTX-PP/PE therapy may be considered as an alternative treatment of ptFSGS in achieving remission by lowering proteinuria and serum creatinine levels. However, the efficacy of combined RTX-PP/PE therapy must be confirmed in randomized-controlled trials.

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Authors and Affiliations

  1. Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, 504 S. Front St, Suite 3C, Harrisburg, PA, 17104, USA

    Panupong Hansrivijit

  2. Division of Nephrology, Department of Medicine, Penn State University College of Medicine, Hershey, PA, 17033, USA

    Nasrollah Ghahramani

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PH and NG performed literature search, citation screening, and data collection. PH analysed the data and drafted the manuscript. PH and NG revised and edited the manuscript for submission.

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Correspondence to Panupong Hansrivijit.

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Hansrivijit, P., Ghahramani, N. Combined rituximab and plasmapheresis or plasma exchange for focal segmental glomerulosclerosis in adult kidney transplant recipients: a meta-analysis. Int Urol Nephrol 52, 1377–1387 (2020). https://doi.org/10.1007/s11255-020-02462-6

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