Introduction:
Post Transplant primary Fsgs Recurrence is a double edged sword.
There is no definite treatment protocol nor there is any option for retransplantation
Methods:
24 year old gentleman diagnosed with primary fsgs, requiring live abo compatible kidney transplantation, complicated by active Antibody mediated rejection and recurrence of primary disease, requiring plasma exchange and rituximab.
Results:
The patient is a 24 year old gentleman, diagnosed with nephrotic syndrome at age 18. He was resistant to both first line and multiple second line drugs. He progressed to end-stage renal disease over 4 years. Started on maintenance hemodialysis in view of fluid overload. His mother was worked up as the prospective renal transplant donor. During this period, received 2 units of FFP in view of bleeding from catheter site. He proceeded with a live ABO compatible kidney transplant from his mother. Post-operatively, in view of delayed graft function, he required hemodialysis. A graft biopsy revealed active amr with recurrence of FSGS, leading to treatment with plasma exchange, IVIG, and rituximab. Immunosuppressive therapy was adjusted due to leucopenia, and the patient was discharged on a regimen of triple immunosuppressive medications along with CMV and cotrimoxazole prophylaxis. Initially, the patient’s post-transplant creatinine level was 4.1 mg/dL, but with treatment, his urine output improved to 2.5 liters per day and his creatinine level decreased to 1.5 mg/dL. Despite improvement, recurrence of FSGS was confirmed via electron microscopy. Plasma exchange sessions were continued once in 2 weeks resulting in further reduction of creatinine to 1.7 mg/dL. However, three months post-transplant, a urinary tract infection exacerbated his renal function, with creatinine levels rising to 2.0mg/dL, though his urine output remained at 3 litres per day.
Conclusions:
This case underscores the challenges of managing recurrent FSGS post-transplant, including the need for ongoing plasma exchange and lack of a definite treatment protocol. Continued monitoring and adjustments to immunosuppressive therapy are crucial for optimizing renal function and managing complications in such patients.
This abstract was presented at mid ISOT conducted at Nasik April 2024
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.