Linked Life Data

15605284

Source:http://linkedlifedata.com/resource/pubmed/id/15605284

Statements in which the resource exists as a subject.
PredicateObject
rdf:type
lifeskim:mentions
pubmed:issue
2
pubmed:dateCreated
2005-1-25
pubmed:abstractText
Recurrence of focal glomerulosclerosis (FSGS) following renal transplantation is a common cause of allograft loss and clinical morbidity. Recent attempts to control proteinuria and morbidity with plasmapheresis (PP) have met with limited success. Our experience with the use of mycophenolate mofetil (MMF) and angiotensin blockade (AB) in the management of refractory FSGS pre transplant suggested its potential benefit in post-transplant recurrence. This report presents our 25-year experience in pediatric renal transplantation of patients with FSGS divided into two treatment eras: Era 1-prior to use of daclizumab (anti-IL-2R) and Era 2-after daclizumab. A total of 179 pediatric patients were transplanted during the 25-year period. FSGS was confirmed in 27 (15%); 16 of 28 allografts (57%) had recurrence of FSGS during the post-transplant period. In Era 1, only 6 of 16 (38%) recurred in the allograft, while 10 of 12 (83%) recurred during Era 2. The odds ratio of recurrence of FSGS in the allograft after induction with anti-IL-2R was 8.3 (95% confidence interval=1.3-52, P =0.02). Only 2 patients in Era 1 received PP, while 10 in Era 2 were entered into an intensive PP protocol followed by maintenance with AB consisting of angiotensin receptor blockers alone, or in combination with angiotensin-converting enzyme inhibitor. Although proteinuria decreased an average of 80+/-16% with PP, the response was variable and severe morbid edema persisted in poor responders. Maximum benefit occurred with the addition of AB and MMF. After a follow-up of 27+/-15 months, proteinuria has shown a sustained decrease of 94+/-8% below baseline. In conclusion, our experience suggests that, with recurrent FSGS, a limited course of PP followed by maintenance therapy with AB and MMF improves symptoms and may preserve allograft function.
pubmed:language
eng
pubmed:journal
pubmed:citationSubset
IM
pubmed:chemical
pubmed:status
MEDLINE
pubmed:month
Feb
pubmed:issn
0931-041X
pubmed:author
pubmed:issnType
Print
pubmed:volume
20
pubmed:owner
NLM
pubmed:authorsComplete
Y
pubmed:pagination
210-6
pubmed:dateRevised
2011-11-17
pubmed:meshHeading
pubmed-meshheading:15605284-Adolescent, pubmed-meshheading:15605284-Angiotensin II Type 1 Receptor Blockers, pubmed-meshheading:15605284-Angiotensin-Converting Enzyme Inhibitors, pubmed-meshheading:15605284-Antibodies, Monoclonal, pubmed-meshheading:15605284-Antibodies, Monoclonal, Humanized, pubmed-meshheading:15605284-Child, pubmed-meshheading:15605284-Child, Preschool, pubmed-meshheading:15605284-Female, pubmed-meshheading:15605284-Florida, pubmed-meshheading:15605284-Glomerulosclerosis, Focal Segmental, pubmed-meshheading:15605284-Graft Survival, pubmed-meshheading:15605284-Humans, pubmed-meshheading:15605284-Immunoglobulin G, pubmed-meshheading:15605284-Immunosuppressive Agents, pubmed-meshheading:15605284-Infant, pubmed-meshheading:15605284-Kidney Transplantation, pubmed-meshheading:15605284-Male, pubmed-meshheading:15605284-Mycophenolic Acid, pubmed-meshheading:15605284-Plasmapheresis, pubmed-meshheading:15605284-Recurrence, pubmed-meshheading:15605284-Treatment Outcome
pubmed:year
2005
pubmed:articleTitle
Recurrent focal glomerulosclerosis in pediatric renal allografts: the Miami experience.
pubmed:affiliation
Division of Pediatric Nephrology, Holtz Children's Hospital, University of Miami, P.O. Box 016960 (M-714), Miami, FL 33101, USA.
pubmed:publicationType
Journal Article, Research Support, Non-U.S. Gov't