Dados do Trabalho

Título

MULTIPLE TARGET THERAPY IN FOCAL SEGMENTAL GLOMERULOSCLEROSIS (FSGS) RECURRENCE: AN EXTERNAL VALIDATION

Introdução

Focal and segmental glomerulosclerosis (FSGS) can recur in 30 to 80% of the recipients after a first kidney transplant, mostly within the first three to six months.There is no consensus regarding the best therapeutic approach for FSGS recurrence. In a nonrandomized pilot trial, Canaud et al. reported that the use of a “multiple target therapy” combining high-dose intravenous cyclosporine, prednisone plus PP for a period of nine months achieved complete remission in 90% of the KTR with no severe adverse events. (6) The current study sought independent external confirmation of the efficacy and safety of such approach for FSGS recurrence.

Material e Método

Single-center, prospective, interventional, non-controlled study investigating the efficacy and safety of multiple target therapy for FSGS recurrence. The population of interest consisted of kidney transplant recipients of all ages who, during the period of 04/20/2016 to 07/11/2017, had the suspicion of FSGS, defined as proteinuria > 2 g/day appearing after transplantation with progressive and sustained values. In the case of patients treated with mTOR inhibitors as part of their immunosuppressive regimen, a washout period was required before FSGS recurrence could be suspected. Patients included in the study received the multiple target therapy composed by high-dose intravenous CsA, prednisone and PP. Based on whether or not a native kidney biopsy was performed patients were included in a confirmed FSGS recurrence group when the native kidney biopsy demonstrated FSGS or minimal change disease, or in the presumed FSGS recurrence group when no native kidney biopsy was available.

Resultados

Thirteen patients were included in the study. All patients required discontinuation of treatment in a median time of 19 days, mostly (80% of patients) due to infectious adverse events. No CR was achieved in the group with confirmed FSGS recurrence, and partial remission (PR) was achieved in two patients (40%) from this group. Two patients (40%) progressed to allograft loss due to FSGS. Among the patients with presumed FSGS recurrence, one (12.5%) had CR, and another one (12.5%) PR. Three progressed to allograft loss due to FSGS.

Discussão e Conclusões

In this prospective, interventional study, the efficacy of the multiple target therapy could not be validated, since infectious complications, mainly CMV events, required the premature discontinuation of the treatment.

Palavras Chave

glomerulonephritis, focal segmental glomerulosclerosis, kidney transplantation, proteinuria.