ACTH Gel in Resistant Focal Segmental Glomerulosclerosis after Kidney Transplantation

Tarek Alhamad, John Manllo DIeck, Usman Younus, Dany Matar, Sami Alasfar, Vikas Vujjini, Devin Wall, Bilal Kanawati, Jochen Reiser, Daniel Brennan, Nada Alachkar

Research output: Contribution to journalArticle

Abstract

Background Treatment of focal segmental glomerular sclerosis (FSGS) after kidney transplantation is challenging with unpredictable outcomes. The objective was to investigate the use of adrenocorticotropic hormone (ACTH) analogue gel in kidney transplant recipients with de novo or recurrent FSGS resistant to therapeutic plasma exchange (TPE) and/or rituximab. Methods We performed a retrospective review of cases of de novo or recurrent resistant FSGS at 2 large US transplant centers between April 2012 and December 2016. Proteinuria was measured by urine protein to creatinine ratio. Results We identified 20 cases of posttransplant recurrent and de novo FSGS resistant to conventional therapy with TPE and rituximab. Mean ± SD age was 49 ± 15.5 years, 14 (70%) were male, 13 (65%) were whites, and 8 (38%) had previous kidney transplants. Median (interquartile range) of recurrent and de novo FSGS was 3 (0.75-7.5) months posttransplant. The majority of patients, 15 (75%), received TPE as a treatment at the time of diagnosis and 10 (50%) received rituximab, which was started before the use of ACTH gel. There was a significant improvement of urine protein to creatinine ratio from a mean ± SD of 8.6 ± 7.6 g/g before ACTH gel to 3.3 ± 2.3 g/g after the use of ACTH gel (P = 0.004). Ten (50%) patients achieved complete or partial remission. Conclusions Although, the response varied among the recipients, ACTH gel might be an effective therapy for posttransplant resistant FSGS cases that fail to respond to TPE and rituximab.

Original languageEnglish (US)
Pages (from-to)202-209
Number of pages8
JournalTransplantation
Volume103
Issue number1
DOIs
StatePublished - Jan 1 2019

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Focal Segmental Glomerulosclerosis
Kidney Transplantation
Adrenocorticotropic Hormone
Sclerosis
Gels
Plasma Exchange
Therapeutics
Creatinine
Urine
Transplants
Kidney
Proteinuria
Proteins
Rituximab

ASJC Scopus subject areas

  • Transplantation

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ACTH Gel in Resistant Focal Segmental Glomerulosclerosis after Kidney Transplantation. / Alhamad, Tarek; Manllo DIeck, John; Younus, Usman; Matar, Dany; Alasfar, Sami; Vujjini, Vikas; Wall, Devin; Kanawati, Bilal; Reiser, Jochen; Brennan, Daniel; Alachkar, Nada.

In: Transplantation, Vol. 103, No. 1, 01.01.2019, p. 202-209.

Research output: Contribution to journalArticle

Alhamad, T, Manllo DIeck, J, Younus, U, Matar, D, Alasfar, S, Vujjini, V, Wall, D, Kanawati, B, Reiser, J, Brennan, D & Alachkar, N 2019, 'ACTH Gel in Resistant Focal Segmental Glomerulosclerosis after Kidney Transplantation' Transplantation, vol. 103, no. 1, pp. 202-209. https://doi.org/10.1097/TP.0000000000002320
Alhamad, Tarek ; Manllo DIeck, John ; Younus, Usman ; Matar, Dany ; Alasfar, Sami ; Vujjini, Vikas ; Wall, Devin ; Kanawati, Bilal ; Reiser, Jochen ; Brennan, Daniel ; Alachkar, Nada. / ACTH Gel in Resistant Focal Segmental Glomerulosclerosis after Kidney Transplantation. In: Transplantation. 2019 ; Vol. 103, No. 1. pp. 202-209.
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abstract = "Background Treatment of focal segmental glomerular sclerosis (FSGS) after kidney transplantation is challenging with unpredictable outcomes. The objective was to investigate the use of adrenocorticotropic hormone (ACTH) analogue gel in kidney transplant recipients with de novo or recurrent FSGS resistant to therapeutic plasma exchange (TPE) and/or rituximab. Methods We performed a retrospective review of cases of de novo or recurrent resistant FSGS at 2 large US transplant centers between April 2012 and December 2016. Proteinuria was measured by urine protein to creatinine ratio. Results We identified 20 cases of posttransplant recurrent and de novo FSGS resistant to conventional therapy with TPE and rituximab. Mean ± SD age was 49 ± 15.5 years, 14 (70{\%}) were male, 13 (65{\%}) were whites, and 8 (38{\%}) had previous kidney transplants. Median (interquartile range) of recurrent and de novo FSGS was 3 (0.75-7.5) months posttransplant. The majority of patients, 15 (75{\%}), received TPE as a treatment at the time of diagnosis and 10 (50{\%}) received rituximab, which was started before the use of ACTH gel. There was a significant improvement of urine protein to creatinine ratio from a mean ± SD of 8.6 ± 7.6 g/g before ACTH gel to 3.3 ± 2.3 g/g after the use of ACTH gel (P = 0.004). Ten (50{\%}) patients achieved complete or partial remission. Conclusions Although, the response varied among the recipients, ACTH gel might be an effective therapy for posttransplant resistant FSGS cases that fail to respond to TPE and rituximab.",
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AU - Matar, Dany

AU - Alasfar, Sami

AU - Vujjini, Vikas

AU - Wall, Devin

AU - Kanawati, Bilal

AU - Reiser, Jochen

AU - Brennan, Daniel

AU - Alachkar, Nada

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N2 - Background Treatment of focal segmental glomerular sclerosis (FSGS) after kidney transplantation is challenging with unpredictable outcomes. The objective was to investigate the use of adrenocorticotropic hormone (ACTH) analogue gel in kidney transplant recipients with de novo or recurrent FSGS resistant to therapeutic plasma exchange (TPE) and/or rituximab. Methods We performed a retrospective review of cases of de novo or recurrent resistant FSGS at 2 large US transplant centers between April 2012 and December 2016. Proteinuria was measured by urine protein to creatinine ratio. Results We identified 20 cases of posttransplant recurrent and de novo FSGS resistant to conventional therapy with TPE and rituximab. Mean ± SD age was 49 ± 15.5 years, 14 (70%) were male, 13 (65%) were whites, and 8 (38%) had previous kidney transplants. Median (interquartile range) of recurrent and de novo FSGS was 3 (0.75-7.5) months posttransplant. The majority of patients, 15 (75%), received TPE as a treatment at the time of diagnosis and 10 (50%) received rituximab, which was started before the use of ACTH gel. There was a significant improvement of urine protein to creatinine ratio from a mean ± SD of 8.6 ± 7.6 g/g before ACTH gel to 3.3 ± 2.3 g/g after the use of ACTH gel (P = 0.004). Ten (50%) patients achieved complete or partial remission. Conclusions Although, the response varied among the recipients, ACTH gel might be an effective therapy for posttransplant resistant FSGS cases that fail to respond to TPE and rituximab.

AB - Background Treatment of focal segmental glomerular sclerosis (FSGS) after kidney transplantation is challenging with unpredictable outcomes. The objective was to investigate the use of adrenocorticotropic hormone (ACTH) analogue gel in kidney transplant recipients with de novo or recurrent FSGS resistant to therapeutic plasma exchange (TPE) and/or rituximab. Methods We performed a retrospective review of cases of de novo or recurrent resistant FSGS at 2 large US transplant centers between April 2012 and December 2016. Proteinuria was measured by urine protein to creatinine ratio. Results We identified 20 cases of posttransplant recurrent and de novo FSGS resistant to conventional therapy with TPE and rituximab. Mean ± SD age was 49 ± 15.5 years, 14 (70%) were male, 13 (65%) were whites, and 8 (38%) had previous kidney transplants. Median (interquartile range) of recurrent and de novo FSGS was 3 (0.75-7.5) months posttransplant. The majority of patients, 15 (75%), received TPE as a treatment at the time of diagnosis and 10 (50%) received rituximab, which was started before the use of ACTH gel. There was a significant improvement of urine protein to creatinine ratio from a mean ± SD of 8.6 ± 7.6 g/g before ACTH gel to 3.3 ± 2.3 g/g after the use of ACTH gel (P = 0.004). Ten (50%) patients achieved complete or partial remission. Conclusions Although, the response varied among the recipients, ACTH gel might be an effective therapy for posttransplant resistant FSGS cases that fail to respond to TPE and rituximab.

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