医学
美罗华
达拉图穆马
局灶节段性肾小球硬化
内科学
肿瘤科
肾
肾小球肾炎
多发性骨髓瘤
淋巴瘤
来那度胺
作者
Andrea Angeletti,Sofia Bin,Alberto Magnasco,Maurizio Bruschi,Paolo Cravedi,Gian Marco Ghiggeri
标识
DOI:10.1016/j.ajt.2023.12.010
摘要
Abstract
Focal segmental glomerulosclerosis (FSGS) is one of the leading causes of kidney failure and it is characterized by a high rate of recurrence after kidney transplant. Moreover, FSGS recurrence is worsened by an increased risk of graft failure. Common therapies for FSGS recurrence mostly consist of plasma exchange treatments, also for prolonged time, and rituximab, with variable efficacy. We report 5 cases of early FSGS recurrence after kidney transplant, resistant to plasma exchange and rituximab treatment that subsequently resolved after combined therapy with rituximab and daratumumab. All cases were negative for genetic FSGS. The combined treatment induced a complete response in all the cases and was well tolerated. We also performed a comprehensive flow cytometry analysis in 2 subjects that may suggest a mechanistic link between plasma cells and disease activity. In conclusion, given the lack of viable treatments for recurrent FSGS, our reports support the rationale for a pilot trial testing the safety/efficacy profile of combined rituximab and daratumumab in posttransplant FSGS recurrence.
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