Published online Jul 18, 2021. doi: 10.5500/wjt.v11.i7.303
Peer-review started: January 30, 2021
First decision: May 5, 2021
Revised: May 10, 2021
Accepted: June 16, 2021
Article in press: June 16, 2021
Published online: July 18, 2021
Focal segmental glomerulosclerosis (FSGS) is one of the most common glomerular diseases leading to kidney failure. FSGS has a high risk of recurrence after kidney transplantation. Prevention of recurrent FSGS using rituximab and/or plasmapheresis has been evaluated in multiple small studies with conflicting results.
FSGS is associated with a high risk of recurrence after kidney transplantation. Plas
This meta-analysis was conducted to assess the effectiveness of rituximab–with or without plasmapheresis–compared with plasmapheresis alone, for the prevention of recurrent FSGS after kidney transplantation.
This meta-analysis and systematic review were performed by first conducting a literature search of the MEDLINE, EMBASE, and Cochrane databases, from inception through March 2021; search terms included ‘FSGS’, ’steroid-resistant nephrotic syndrome’, ‘rituximab’, and ‘plasmapheresis’. We identified studies that assessed the risk of post-transplant FSGS after use of rituximab with or without plasmapheresis, or plasmapheresis alone.
Eleven studies, with a total of 399 kidney transplant recipients with FSGS, evaluated the use of rituximab with or without plasmapheresis; thirteen studies, with a total of 571 kidney transplant recipients with FSGS, evaluated plasmapheresis alone. Post-transplant FSGS recurred relatively early. There was no significant difference in recurrence between the group that received rituximab (with or without plasmaphe
The use of rituximab with or without plasmapheresis, or plasmapheresis alone, is not associated with a lower risk of FSGS recurrence after kidney transplantation.
This meta-analysis is among the first to report that the use of preemptive rituximab, either alone or in combination with plasmapheresis, or plasmapheresis alone, did not alter the recurrence risk of FSGS after kidney transplantation.