• Cyril Garrouste, Guillaume Canaud, Mathias Büchler, Joseph Rivalan, Charlotte Colosio, Frank Martinez, Julien Aniort, Caroline Dudreuilh, Bruno Pereira, Sophie Caillard, Carole Philipponnet, Dany Anglicheau, and Anne Elisabeth Heng.
• 1 Clermont-Ferrand University Hospital, Department of Nephrology, Clermont-Ferrand, France. 2 Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. 3 Paris Descartes, Sorbonne Paris Cité University, Paris, France. 4 Centaure Foundation and Labex Transplantex, Necker Hospital, Paris, France. 5 CHRU and FHU Transplantation, Department of Nephrology and Clinical Immunology, Tours, France. 6 EA 4245 Dendritic Cells, Immunomodulation and Grafts, François Rabelais University, Tours, France. 7 CHU Pontchaillou, Department of Nephrology, Rennes, France. 8 Department of Nephrology, Hôpital Maison Blanche-CHU Reims, Reims, France. 9 Biostatistics Unit (DRCI), University Hospital Clermont-Ferrand, Clermont-Ferrand, France. 10 University Hospital, Nephrology-Transplantation Department, Strasbourg, France. 11 Université Clermont 1, Clermont-Ferrand, France.
• Transplantation. 2017 Mar 1; 101 (3): 649-656.

BackgroundRituximab has shown encouraging results for the treatment of kidney transplantation recipients with focal segmental glomerulosclerosis (FSGS) recurrence. However, the correct, opportune, and safe use of rituximab for this indication remains to be determined.MethodsThis multicenter retrospective study reports on 19 new cases aged 35 (15-66) years who developed FSGS recurrence at 12 (1.5-27) days posttransplantation. Initial treatment consisted of plasma exchanges (PE), high doses of calcineurin inhibitors, and steroids. Rituximab was introduced either immediately (N = 6) or after failure of the initial treatment (N = 10) or failed attempted weaning from PE (N = 3).ResultsOverall, we observed 9 of 19 complete remissions and 3 of 19 partial remissions. Estimated glomerular filtration rates (Modification of Diet in Renal Disease 4) were significantly higher in the responding patients than in nonresponding patients at month (M)12, M36, and M60. Overall, kidney survival at 5 years was 77.4% (95% range, 41.9-92.7). The 5-year graft survival rates in the responding patients and the nonresponding patients were 100% and 36.5%, respectively (P = 0.01). A further course of rituximab was required for 4 patients as a result of FSGS relapse, with good results. During the first year after renal transplantation, 14 patients developed severe infections (16 bacterial, 4 viral, 1 parasitic).ConclusionsIn kidney transplantation recipients with recurrent FSGS, rituximab therapy may be a recommended treatment for cases that have failed either the initial treatment or weaning from PE.

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