UK experience of ofatumumab in recurrence of focal segmental glomerulosclerosis post-kidney transplant

Reynolds, B. C., Lamb, A., Jones, C. A., Yadav, P., Tyerman, K. S. and Geddes, C. C. (2022) UK experience of ofatumumab in recurrence of focal segmental glomerulosclerosis post-kidney transplant. Pediatric Nephrology, 37(1), pp. 199-207. (doi: 10.1007/s00467-021-05248-9) (PMID:34383125) (PMCID:PMC8674165)

Abstract

Background: Steroid-resistant nephrotic syndrome (SRNS), commonly caused by focal segmental glomerulosclerosis (FSGS), is associated with progression to stage 5 chronic kidney disease, requirement for kidney replacement therapy and a risk of disease recurrence post-kidney transplantation. Ofatumumab (OFA) is a fully humanised monoclonal antibody to CD20, with similar mechanisms of action to rituximab (RTX). Methods: We report a case series of seven UK patients (five paediatric, two adult), all of whom developed FSGS recurrence after kidney transplantation and received OFA as part of their therapeutic intervention. All also received concomitant plasmapheresis. The 2-year outcome of these seven patients is reported, describing clinical course, kidney function and proteinuria. Results: Four patients (all paediatric) achieved complete urinary remission with minimal proteinuria 12 months post-treatment. Three of those four also had normal graft function. Two patients showed partial remission—brief improvement to non-nephrotic proteinuria (197 mg/mmol) in one patient, maintained improvement in kidney function (estimated glomerular filtration rate 76 ml/min/1.73 m2) in the other. One patient did not demonstrate any response. Conclusions: OFA may represent a useful addition to therapeutic options in the management of FSGS recurrence post-transplantation, including where RTX has shown no benefit. Concomitant plasmapheresis in all patients prevents any definitive conclusion that OFA was the beneficial intervention.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Geddes, Dr Colin and Reynolds, Dr Ben
• Authors: Reynolds, B. C., Lamb, A., Jones, C. A., Yadav, P., Tyerman, K. S., and Geddes, C. C.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Pediatric Nephrology
• Publisher: Springer
• ISSN: 0931-041X
• ISSN (Online): 1432-198X
• Published Online: 12 August 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in Pediatric Nephrology 37(1): 199-207
• Publisher Policy: Reproduced under a Creative Commons License