| Institution: | 1. Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France;2. Assistance Publique des Hôpitaux de Paris, Service de Néphrologie et Transplantation, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France;3. Assistance Publique des Hôpitaux de Paris (AP-HP, Service de Néphrologie et Transplantation Centre de Référence Maladie Rare «Syndrome Néphrotique Idiopathique», Hôpitaux Universitaires Henri-Mondor, Univ Paris Est Créteil, INSERM, IMRB, Créteil, France;4. Service de Néphrologie et Immunologie Clinique, CHRU de Tours, Tours, France;5. Service de Néphrologie, University Hospital, Strasbourg, France;6. Service de Néphrologie, Transplantation, Dialyse et Aphérèses, CHU de Bordeaux, Bordeaux, France;7. Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France;8. Assistance Publique des Hôpitaux de Paris, Hôpital Universitaire Tenon, Urgences Néphrologiques et Transplantation Rénale, Université de Paris, Paris, France;9. Service de Néphrologie, CHRU, Rouen, France;10. Service de Néphrologie, Dialyse et Transplantation, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France;11. Service de Néphrologie, Dialyse et Transplantation, CHU Besançon, Besançon, France;12. Service de Néphrologie-Médecine Interne-Dialyse-Transplantation, CHU d'Amiens, Amiens, France;13. Service de Néphrologie-Hémodialyse-Transplantation Rénale, CHU de Poitiers, Poitiers, France;14. Département de Néphrologie et Transplantation d’Organes, CHU Toulouse, INSERM U1043, IFR–BMT, Université Paul Sabatier, Toulouse, France;15. Service de Néphrologie, Dialyse et Transplantation, CHU Limoges, Limoges, France;16. Assistance Publique des Hôpitaux de Paris, Service de Néphrologie, Hôpital Universitaire Bichat-Claude-Bernard, Université de Paris, Paris, France;17. Unité de Biostatistiques (DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France;18. Service de Néphrologie et Transplantation, CHU Caen, Caen, France;19. Service de Néphrologie, CHU Reims, Reims, France;20. Service de Néphrologie et Transplantation, CHU Saint-Etienne, Saint-Etienne, France;21. Service de Néphrologie-Dialyse-Transplantation, CHU Angers, Angers, France;22. Service de Néphrologie, Rennes University Hospital, Rennes, France |
| Abstract: | Rituximab (RTX) therapy for primary focal segmental glomerulosclerosis recurrence after kidney transplantation (KT) has been extensively debated. We aimed to assess the benefit of adding RTX to plasmapheresis (PP), corticosteroids, and calcineurin inhibitors (standard of care, SOC). We identified 148 adult patients who received KT in 12/2004–12/2018 at 21 French centers: 109 received SOC (Group 1, G1), and 39 received immediate RTX along with SOC (Group 2, G2). In G1, RTX was introduced after 28 days of SOC in the event of failure (G1a, n = 19) or PP withdrawal (G1b, n = 12). Complete remission (CR) was achieved in 46.6% of patients, and partial remission (PR) was achieved in 33.1%. The 10-year graft survival rates were 64.7% and 17.9% in responders and nonresponders, respectively. Propensity score analysis showed no difference in CR+PR rates between G1 (82.6%) and G2 (71.8%) (p = .08). Following the addition of RTX (G1a), 26.3% of patients had CR, and 31.6% had PR. The incidence of severe infections was similar between patients treated with and without RTX. In multivariable analysis, infection episodes were associated with hypogammaglobulinemia <5 g/L. RTX could be used in cases of SOC failure or remission for early discontinuation of PP without increasing the risk of infection. |
