Benefit of B7-1 staining and abatacept for treatment-resistant post-transplant focal segmental glomerulosclerosis in a predominantly pediatric cohort: time for a reappraisal

被引：16

作者：

Burke, George W., III ^{[1
]}

Chandar, Jayanthi ^{[2
]}

Sageshima, Junichiro ^{[3
]}

Ortigosa-Goggins, Mariella ^{[4
,5
]}

Amarapurkar, Pooja ^{[6
]}

Mitrofanova, Alla ^{[7
]}

Defreitas, Marissa J. ^{[8
]}

Katsoufis, Chryso P. ^{[8
]}

Seeherunvong, Wacharee ^{[8
]}

Centeno, Alexandra ^{[9
]}

Pagan, Javier ^{[4
,5
]}

Mendez-Castaner, Lumen A. ^{[4
,5
]}

Mattiazzi, Adela D. ^{[4
,5
]}

Kupin, Warren L. ^{[4
,5
]}

Guerra, Giselle ^{[4
,5
]}

Chen, Linda J. ^{[1
]}

Morsi, Mahmoud ^{[1
]}

Figueiro, Jose M. G. ^{[1
]}

Vianna, Rodrigo ^{[1
,10
]}

Abitbol, Carolyn L. ^{[8
]}

Roth, David ^{[4
,5
]}

Fornoni, Alessia ^{[4
]}

Ruiz, Phillip ^{[11
]}

Ciancio, Gaetano ^{[1
]}

Garin, Eduardo H. ^{[12
]}

机构：

[1] Univ Miami, Miami Transplant Inst, Dept Surg, Div Kidney Pancreas Transplantat,Miller Sch Med, 1801 NW 9th Ave,Highland Profess Bldg, Miami, FL 33136 USA

[2] Univ Miami, Miami Transplant Inst, Dept Pediat, Div Pediat Kidney Transplantat,Miller Sch Med, Miami, FL 33136 USA

[3] Univ Calif Davis, Dept Surg, Div Transplant Surg, Sch Med, Sacramento, CA 95817 USA

[4] Univ Miami, Katz Family Div Nephrol & Hypertens, Dept Med, Miller Sch Med, Miami, FL 33136 USA

[5] Univ Miami, Miami Transplant Inst, Miller Sch Med, Miami, FL 33136 USA

[6] Emory Univ, Dept Med, Div Nephrol, Sch Med, Atlanta, GA 30309 USA

[7] Univ Miami, Dept Med, Katz Family Div Nephrol & Hypertens, Res,Miller Sch Med, Miami, FL 33136 USA

[8] Univ Miami, Dept Pediat, Div Pediat Nephrol, Miller Sch Med, Miami, FL 33136 USA

[9] Jackson Mem Hosp, Miami Transplant Inst, Transplant Clin Pharm Serv, Miami, FL 33136 USA

[10] Univ Miami, Miami Transplant Inst, Dept Surg, Div Liver & GI Transplantat,Miller Sch Med, Miami, FL 33136 USA

[11] Univ Miami, Miami Transplant Inst, Dept Surg, Transplant Pathol,Miller Sch Med, Miami, FL 33136 USA

[12] Univ Florida, Dept Pediat, Div Nephrol, Sch Med, Gainesville, FL 32610 USA

来源：

PEDIATRIC NEPHROLOGY | 2023年 / 38卷 / 01期

关键词：

Podocyte; Proteinuria; Nephrotic syndrome; Focal segmental glomerulosclerosis; Kidney transplantation; B7-1; Abatacept; FOOT PROCESS EFFACEMENT; MINIMAL CHANGE DISEASE; RECURRENT GLOMERULONEPHRITIS; KIDNEY-TRANSPLANTATION; PODOCYTES; BELATACEPT; EXPRESSION; RITUXIMAB; BLOCKADE;

D O I：

10.1007/s00467-022-05549-7

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

Background Primary FSGS manifests with nephrotic syndrome and may recur following KT. Failure to respond to conventional therapy after recurrence results in poor outcomes. Evaluation of podocyte B7-1 expression and treatment with abatacept (a B7-1 antagonist) has shown promise but remains controversial. Methods From 2012 to 2020, twelve patients developed post-KT FSGS with nephrotic range proteinuria, failed conventional therapy, and were treated with abatacept. Nine/twelve (< 21 years old) experienced recurrent FSGS; three adults developed de novo FSGS, occurring from immediately, up to 8 years after KT. KT biopsies were stained for B7-1. Results Nine KTRs (75%) responded to abatacept. Seven of nine KTRs were B7-1 positive and responded with improvement/resolution of proteinuria. Two patients with rFSGS without biopsies resolved proteinuria after abatacept. Pre-treatment UPCR was 27.0 +/- 20.4 (median 13, range 8-56); follow-up UPCR was 0.8 +/- 1.3 (median 0.2, range 0.07-3.9, p < 0.004). Two patients who were B7-1 negative on multiple KT biopsies did not respond to abatacept and lost graft function. One patient developed proteinuria while receiving belatacept, stained B7-1 positive, but did not respond to abatacept. Conclusions Podocyte B7-1 staining in biopsies of KTRs with post-transplant FSGS identifies a subset of patients who may benefit from abatacept.

引用

页码：145 / 159

页数：15

共 44 条

[21] Belatacept in recurrent focal segmental glomerulosclerosis after kidney transplantation [J].