BACKGROUND Treatment of post-transplant focal segmental glomerulosclerosis (FSGS) recurrence is still debated. The use of the fully human anti-CD20 monoclonal antibody ofatumumab has been suggested. CASE-DIAGNOSIS/TREATMENT Two boys with FSGS received a kidney transplantation at the age of 15 years from a deceased and a living donor. Maintenance therapy consisted of calcineurin inhibitors, antiproliferative agents, and prednisone. Early post-transplant FSGS recurrence was observed after 2 and 3 days. Rituximab infusion and plasmapheresis sessions were performed with transient clinical improvement in the first patient, and no apparent response in the second patient. Both patients were treated with two ofatumumab infusions, which induced in patient #1 a complete and stable remission for more than 12 months and in patient #2 a partial remission with a progressive reduction of proteinuria and normalization of serum protein levels. CONCLUSIONS Ofatumumab may be a therapeutic option for post-transplant FSGS recurrence in patients who respond poorly to rituximab.

中文翻译：

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Ofatumumab抢救治疗在局灶性节段性肾小球硬化症移植后复发中的应用。

背景技术关于移植后局部节段性肾小球硬化症（FSGS）复发的治疗仍存在争议。已经提出使用完全人抗CD20单克隆抗体ofatumumab。病例诊断/治疗两名患有FSGS的男孩在15岁时从死者和活着的供体中接受了肾脏移植。维持疗法包括钙调神经磷酸酶抑制剂，抗增殖剂和泼尼松。移植后2天和3天观察到早期FSGS复发。利妥昔单抗输注和血浆置换治疗在第一例患者中进行了短暂的临床改善，而第二例患者中无明显反应。两名患者均接受了两次奥法木单抗输注，在1号患者中诱导了超过12个月的完全稳定的缓解，在2号患者中诱导了部分缓解，并逐渐减少了蛋白尿并使血清蛋白水平正常化。结论对于对利妥昔单抗反应较差的患者，Ofatumumab可能是移植后FSGS复发的治疗选择。