Rituximab or plasmapheresis for prevention of recurrent focal segmental glomerulosclerosis after kidney transplantation: A systematic review and meta-analysis

Table 1 Characteristics of included studies evaluating the outcomes of preemptive plasmapheresis

Ref.	Country	Design	n (%)	Population	Age	PP protocol	Def of recurrence	Recurrence	Graft survival	Quality assessment
Kawaguchi et al[20], 1994	Japan	Retrospective	14	FSGS children	2-12 yr at FSGS Dx	2-3 sessions immediately before KT (-5, -3, and -1 d) ATG 7-14 d pre-op	N/A	3/8 (38%) vs 4/6 (67%)	93% graft survival in overall cohort	Fair, 4-1-2
Otsubo et al[21], 1999	Japan	Retrospective	37	FSGS undergoing KT	22 yr at KT	N/A	Clinical and biopsy in all cases	4/19 (21%) vs 9/18 (50%)	75%at 5 yr, 63% at 10 yr	Fair, 4-1-2
Iguchi et al[32], 1997	Japan	Prospective cohort	11	FSGS undergoing KT	33.3 (20-43) yr	3 sessions of pre-op PP within 3 d before KT	Clinical and/or pathologic	1/3 (33%) vs 4/8 (50%)	100% vs 63.6%	Fair, 4-2-2
Ohta et al[33], 2001	Japan	Retrospective	21	FSGS children	Age of FSGS onset 69.5 ± 36.4 mo (range 9-134 mo)	1-2 sessions immediately before KT (-5, -3, and -1 d). Therapeutic PP until reduction of proteinuria	Clinical and/or pathologic	5/15 (33%) vs 4/6 (67%)	13/15 vs 3/5 (1 death with functioning graft in Non-PP)	Fair, 4-2-2
Somers and Baum[34], 2009	United States	Retrospective	52	FSGS children	12.5 yr	N/A	N/A	5/19 (26%) vs 18/33 (55%)	Overall, 11/52 graft loss	Fair, 4-1-2
Gonzalez et al[35], 2011	United States	Retrospective	34	FSGS children	Age at KT: 13 ± 5 yr. Age at FSGS diagnosis: 5.3 yr (n = 19, recurrence group), 6.9 yr (n = 15, no recurrence group)	1-10 sessions	Clinical and/or pathologic	9/17 (53%) vs 10/17 (59%)	Graft loss at 3 yr: 25% in recurrence group vs 20% in non-recurrence	High, 4-2-3
Miyauchi et al[25], 2011	Japan	Prospective cohort	25	FSGS undergoing KT	N/A	N/A	N/A	3/9 (33%) vs 2/4 (50%)	N/A	Low, 3-1-1
Park et al[26], 2014	South Korea	Retrospective	27	FSGS undergoing KT	Age at KT: 39 ± 14 yr and 36 ± 11 yr	PP and IVGV infusion after each session of PP prior to transplantation	Clinical confirmed by biopsy	1/4 (25%) vs 5/18 (27%)	FSGS with recurrence had less graft survival than those without recurrence (P = 0.01)	High, 4-2-3
Okumi et al[27], 2015	Japan	Retrospective	38	FSGS undergoing KT	N/A	N/A	N/A	4/10 (40%) vs 2/5 (40%)	5/38 graft loss overall	Low, 3-1-1
Verghese et al[36], 2018	United States	Retrospective	57	FSGS children	Age at KT: 13.2 ± 4.5 yr (after 2006 with PP) vs 10.4 ± 5.4 yr (before 2006, no PP)	LDKT: 3 sessions PP pre-op. DDKT: 1 session of PP pre-op. Post-op: 5 sessions of PP every other day starting POD1	Biopsy; if unable to do biopsy, persistent nephrotic range proteinuria	7/26 (27%) vs 8/31 (26%)	Death-censored graft survival not sig different (P = 0.61)	High, 4-2-3
Koyun et al[37], 2019	Turkey	Retrospective	46	FSGS children	Age at KT: 7.2 ± 1.2 yr (PP) vs 10.7 ± 4.5 yr (no PP)	LDKT: 2-5 sessions of PP pre-op. DDKT: 1 session of PP pre-op. Post-op: 5 session of early PP	N/A	3/6 (50%) vs 5/40 (12.5%)	N/A	Low, 3-1-1
Campise et al[38], 2019	Italy	Retrospective	73	FSGS undergoing KT	Age at FSGS Dx: 27 (15-35) yr. Age at KT: 41 (38-52) yr	2003-2008: post-transplant PP only 2008-2014: 1 session immediately before surgery and 3 sessions per week for 3 consecutive weeks from POD1	Post-transplant proteinuria; confirmed by biopsy	Biopsy-proven: 5/21 (24%) vs 12/52 (23%)	Death-censored graft survival: 81% (17/21) vs 84% (44/52) (P = 0.7022)	High, 4-2-3
Uffing et al[8], 2020	United States, Europe, Brazil	Retrospective, multicenter	176	FSFS adults undergoing KT	Age at KT: 38 (29–47) yr. Age at FSGS Dx: 27 (17-40) yr	N/A	N/A	9/22 (41%) vs 48/154 (31%)	Graft failure 15% w/o recurrence and 39% with recurrence	High, 4-2-3

N: Number; ESKD: End-stage kidney disease; FSGS: Focal segmental glomerulosclerosis; PP: Plasmapheresis; KT: Kidney transplantation; RTX: Rituximab; N/A: Not available.