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Rituximab for recurrence of primary focal segmental glomerulosclerosis after kidney transplantation: Results of a nationwide study. 2021
Camille Lanaret, and
Dany Anglicheau, and
Vincent Audard, and
Mathias Büchler, and
Sophie Caillard, and
Lionel Couzi, and
Paolo Malvezzi, and
Laurent Mesnard, and
Dominique Bertrand, and
Franck Martinez, and
Vincent Pernin, and
Didier Ducloux, and
Coralie Poulain, and
Antoine Thierry, and
Arnaud Del Bello, and
Jean P Rerolle, and
Clarisse Greze, and
Charlotte Uro-Coste, and
Julien Aniort, and
Céline Lambert, and
Nicolas Bouvier, and
Betoul Schvartz, and
Nicolas Maillard, and
Johnny Sayegh, and
Julie Oniszczuk, and
Marie-Pascale Morin, and
Christophe Legendre, and
Nassim Kamar, and
Anne E Heng, and
Cyril Garrouste
Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.
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.
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