Review of plasma exchange and rituximab for prevention of recurrent focal segmental glomerulosclerosis after a prior graft loss

Table 1 Summary of 11 included studies including patient-level data where available

No.	Ref.	Patient number	Number of prior KTs	Gender	Age at index KT	pPE	pRTX	Recurrence	Follow-up time	Outcome at last follow-up
1	Gohh et al[10]							3/6	8-41 months
		1	1	M	33	+		+		Graft dysfunction
		2	1	F	46	+		+		GF
		3	1	F	9	+		+		GF
		4	1	F	45	+		-
		5	2	M	41	+		-
		6	1	M	45	+		-
2	Audard et al[11]							0/4	15–54 months
		7	1	F	33	+	+	-
		8	1	M	43		+	-
		9	1	F	28		+	-
		10	1	M	40	+	+	-
3	Couloures et al[12]							0/1	12 months
		11	1	M	18	+		-
4	Meyer et al[13]							1/1
		12	1	F	28	+ (IA)		+	24 months	Stable, creatinine clearance: 97 mL/min
5	Chikamoto et al[14]							0/1	36 months
		13	1	F	8	+	+	-
6	Valdivia et al[15]							1/3	10 months	All have functioning grafts, 2 had complete response
		14	1			+		+
		15	2			+		-
		16	2			+		-
7	Vallianou et al[16]							3/3	12 months
		17	1			+		+
		18	1			+		+		Remission
		19	2			+		+		GF
8	Naciri Bennani et al[17]							5/5	4-10 years	1 GF, 2 dependent on IA, 2 in remission
		20	2			+	+	+
		21	2			+	+	+
		22	2			+	+	+
		23	2			+	+	+
		24	1			+	+	+
9	Gonzalez et al[18]							1/3	3 years	2 GF
		25	2			+		+
		26	2			+		-
		27	2			+		-
10	Mahesh et al[19]							0/3
		28	1			+		-		Death
		29	1			+		-
		30	1			+		-		GF (rejection)
11	Auñón et al[20]							1/2	71 months
		31	1				+	+
		32	1				+	-

Rituximab dose given in mg/m² body surface area. KTs: Kidney transplant(s); pPE: Prophylactic plasma exchange; pRTX: Prophylactic rituximab; GF: Graft failure; IA: Immunoadsorption.

Table 2 Rates of recurrence following prophylactic use of plasma exchange or rituximab

Prophylaxis (n)	Recurrence (%)	No recurrence (%)
PE only (20)	9 (45)	11 (55)
RTX only (4)	1 (25)	3 (75)
PE + RTX (8)	5 (63)	3 (37)
Total (32)	15 (47)	17 (53)

PE: Plasma exchange; RTX: Rituximab.

Table 3 Individual patient outcomes after treatment for re-recurrence

Patient number	tPE	tPE regime	tRTX	tRTX regime	Treatment outcome
1	+	PE with replacement fluid of one plasma volume of 3.33% albumin solution (0.9% saline and 5% albumin n a 1:2 ratio)	-	-	PR
2	+		-	-	PR
3	+		-	-	NR
12	+	Immunoadsorption 4 times, 10-g of immunoglobulins substituted once	+	375 mg/m2, 3 doses	PR
18	+	1.5 times plasma volume exchange, replaced by a human albumin solution 5%. 3 daily sessions, followed by three-times-a-week for 3 weeks	+	2 doses of 1 g each, 2 weeks apart	CR for 1 year
19	+		+		NR
20	+	Alternate day for 2 weeks, then adapted to proteinuria level. Steroids at 1 mg/kg/day for 3 weeks and then slowly tapered	+	375 mg/m2 of body surface area at the 4th and 8th apheresis sessions	PR
21	+		+		GF
22	+		+		PR
23	+		+		CR
24	+		+		PR

Patient numbers are from Table 1. CR: Complete remission; PR: Partial remission; NR: No remission; GF: Graft failure; tPE: Therapeutic plasma exchange; tRTX: Therapeutic rituximab.