PLASMA EXCHANGE AND PATIENT ADMINISTERED SUBCUTANEOUS IMMUNOGLOBULIN FOR TREATMENT OF RECURRENT FOCAL SEGMENTAL GLOMERULOSCLEROSIS POST-KIDNEY TRANSPLANTATION
Zena Barakat1, Dawn Richardson1, Mathew C Mathew1 1Launceston General Hospital, Launceston, TAS, Australia
Abstract
Background:
Recurrence of focal segmental glomerulosclerosis (FSGS) post-kidney transplantation is a significant problem, with up to 60% of patients experiencing disease recurrence. A circulating factor mediates FSGS, and treatment is aimed at removing this factor through plasma exchange (PLEX) or B-cell-depletion. PLEX combined with intravenous immunoglobulin (IVIg) is an optional therapy; however, this can be exceptionally time-consuming.
Case Report:
We present the case of a 28-year-old male with end-stage kidney disease secondary to primary FSGS who received a kidney transplant from a living-related donor. The patient developed post-transplantation nephrotic-range proteinuria, and kidney biopsy demonstrated recurrence of FSGS. A trial of rituximab was unsuccessful; thus, we treated him with PLEX and IVIg. This treatment required three sessions of 4-hour PLEX per week and a 3-hour session of IVIg, totalling 15 hours per week. Such management represented a high treatment burden with considerable social, psychological, and financial impacts. We transitioned the IVIg to subcutaneous immunoglobulin (scIg) to reduce treatment time and taught him to self-administer this at home. This in combination with reducing the PLEX to two 3-hour sessions reduced his in-centre treatment time to 6 hours. This lessened the treatment burden, enabling him to return to work. Five years on, he continues to have excellent graft function with a creatinine of 83µmol/L and urine albumin-creatinine-ratio of 65mg/mmol.
Conclusions:
This case highlights that when treating FSGS recurrence post-transplantation, PLEX and patient-administered scIg at home can be effective. This method reduces the amount of treatment time needed and improves patients’ quality of life, allowing them to participate in work, family, and social activities. Enabling patients to self-administer subcutaneous immunoglobulin therapy is a viable treatment option in this situation.
Biography
Zena Barakat is a first year advanced trainee in Nephrology at Launceston General Hospital in Tasmania. She is currently completing a higher degree by research at the University of Melbourne exploring the epidemiology and outcomes after kidney injury using data linkage.