Abstract
Background
Relapsing nephrotic syndrome (NS) after transplantation can be a challenge to treat. The result of the consequent long-lasting proteinuria is the loss of the graft. Disease recurrence after renal transplantation occurs in around half of cases, and the efficacy of therapeutic strategies is often limited. Recently, ofatumumab, a second-generation and fully human anti-CD20 monoclonal antibody, has been shown to be effective in severe situations.
Methods
We retrospectively collected data from the medical records of children with recurrence of NS after renal transplantation treated with ofatumumab in France, after failure of previous treatments.
Results
Six patients were included in this study in five centers with a median duration of follow-up of 10.5 months. Two different ofatumumab regimens were administered. The primary outcome was proteinuria at 6 months after the last dose of ofatumumab. No patient achieved a complete remission, 3/6 had a partial remission, and 3/6 had no response to ofatumumab. Four patients exhibited a minor allergic reaction with the first infusion. One patient died of infection, as a consequence of multiple factors. No malignancies were observed; however, the time of follow-up was not sufficient to see such disease.
Conclusions
Altogether, these results suggest ofatumumab has a poor efficacy in treating recurrence of NS after renal transplantation. However, it could be discussed in multidrug-resistant refractory NS, but infectious complications and overimmunosuppression have to be balanced. There is a need for further studies to confirm these findings and safety and to determine a standardized protocol in this indication.
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Abbreviations
- CD:
-
Cluster of differentiation
- CKD 5:
-
Stage 5 chronic kidney disease
- CNI:
-
Calcineurin inhibitor
- CNIL:
-
National Commission of Information Technology and Liberties
- FRNS:
-
Frequently relapsing nephrotic syndrome
- FSGS:
-
Focal and segmental glomerular sclerosis
- IAds:
-
Immunoadsorption sessions
- INS:
-
Idiopathic nephrotic syndrome
- IV:
-
Intravenous
- IVIG:
-
Intravenous immunoglobulins
- mAb:
-
Monoclonal antibody
- MCD:
-
Minimal change disease
- MMF:
-
Mycophenolate mofetil
- NS:
-
Nephrotic syndrome
- RTX:
-
Rituximab
- SDNS:
-
Steroid-dependent nephrotic syndrome
- SRNS:
-
Steroid-resistant nephrotic syndrome
- SSNS:
-
Steroid-sensitive nephrotic syndrome
- UPCR:
-
Urine protein/creatinine ratio
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The data were coded and used in accordance with rule MR004 of the French data protection authority (CNIL). Oral consent was obtained for each patient, in accordance with French ethical standards.
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Bernard, J., Lalieve, F., Sarlat, J. et al. Ofatumumab treatment for nephrotic syndrome recurrence after pediatric renal transplantation. Pediatr Nephrol 35, 1499–1506 (2020). https://doi.org/10.1007/s00467-020-04567-7
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DOI: https://doi.org/10.1007/s00467-020-04567-7