CLINICAL PROFILE AND TREATMENT OUTCOMES OF THERAPEUTIC APHERESIS FOR RECURRENT FOCAL SEGMENTAL GLOMERULOSCLEROSIS AFTER KIDNEY TRANSPLANTATION

 

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CLINICAL PROFILE AND TREATMENT OUTCOMES OF THERAPEUTIC APHERESIS FOR RECURRENT FOCAL SEGMENTAL GLOMERULOSCLEROSIS AFTER KIDNEY TRANSPLANTATION

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Chimezie Godswill
Okwuonu
Chimezie Godswill Okwuonu getchimezie@yahoo.com Federal Medical Center Internal Medicine Umuahia, Abia State Nigeria *
Muzamil Olamide Hassan mhassan@oauife.edu.ng Obafemi Awolowo University Internal Medicine Ile Ife, Osun Nigeria -
Olalekan Eziekel Ojo ayolekan2001@yahoo.co.uk Federal Medical Center Internal Medicine Owo, Ondo State Nigeria -
Rasheed Abiodun Balogun rb8mh@uvahealth.org University of Virginia Health Division of Nephrology Charlottesville United States -
 
 
 
 
 
 
 
 
 
 
 

Recurrence of focal segmental glomerulosclerosis (FSGS) following kidney transplantation remains a significant cause of allograft loss. Much remains unknown about the efficacy of apheresis treatments and the factors that determine favorable treatment outcomes.


This retrospective cohort study involved adult patients who developed recurrent FSGS in the post-transplant period over six years, from January 1, 2017, to December 31, 2022. Twenty patients with biopsy-confirmed FSGS who received therapeutic apheresis as part of their treatment regimen were included. Demographic data, transplant characteristics, procedure details, urine protein levels, and other relevant variables were retrieved. Data were compiled in an Excel spreadsheet and analyzed using the Statistical Package for the Social Sciences (SPSS, IBM NY, 2023, version 29). A p-value of less than 0.05 was considered statistically significant.


Data from 20 patients encompassing 169 therapeutic apheresis sessions were analyzed. Of these, 15 patients (75%) achieved remission, while 5 (25%) did not. The median time to remission was 6 months, and the median number of apheresis sessions was 7 (interquartile range [IQR] = 2–13). There was no significant difference in time to remission between patients with complete and partial remission. Receiving more than five apheresis sessions (adjusted odds ratio [AOR] = 1.9, 95% CI = 1.5–11.5) and having lower baseline proteinuria at treatment initiation (AOR = 2.5, 95% CI = 2.3–7.9, p = 0.04) were independent predictors of remission. The complication rate was 11%, with hypocalcemia being the most common, occurring in 6% of cases. One mortality was recorded during apheresis, yielding a procedure-related mortality rate of 0.006%.


Initiating treatment at lower levels of proteinuria (i.e., earlier in the course of disease recurrence) and increasing the number of apheresis sessions appear to enhance the likelihood of remission in this cohort. The procedure was generally well tolerated, with few reversible adverse events. However, vigilant monitoring remains essential for optimal management. This abstract was also submitted for presentation at the American Society for Apheresis annual meeting in Denver, Colorado April 2026.


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