B cell depletion was confirmed after the single dose and no further doses were given. Two months post-rituximab, the proteinuria improved, Pr/Cr 2.6 and PP were continued twice weekly. 4. Discussion In this retrospective chart review, we found that three out of four cases (75%) with recurrent FSGS post-transplantation had a favorable response to the combination of rituximab and plasmapheresis find protocol with complete remission. One child who attained complete remission relapsed and subsequently received another dose of rituximab with improvement in proteinuria. One child demonstrated a partial remission of proteinuria, but it was not sustained. eGFR was stable in all patients, even in the child with persistent nephrotic-range proteinuria (Case 1).

There were no adverse events related to rituximab such as infection or malignancy over the entire follow-up period in all four cases. Rituximab is a chimeric monoclonal antibody against the CD-20 antigen which results in depletion of B-lymphocytes. Its beneficial role in the treatment of nephrotic syndrome was discovered incidentally during treatment of idiopathic thrombocytopenic pupura in a patient with nephrotic syndrome [12] and in treatment of post-transplant lymphproliferative disorder in a pediatric renal transplant recipient with FSGS recurrence [13]. Since then, rituximab treatment for recurrent FSGS has been reported with mixed results. Yabu et al. described failure of rituximab used as a single agent in four adult transplant recipients [14]. However, in seven adults, the combined treatment of PP and rituximab induced complete or partial remission in 71.

4% [15]. Pediatric patients may respond more favorably to rituximab [4]. A review of reported cases demonstrated a positive response to rituximab for the treatment of recurrent FSGS in 80% of pediatric transplant patients (Table 2) [4, 13, 16�C21]. Of 15 cases (age 10.4 �� 4.5), complete remission was achieved in 10 (67%) and partial remission in 2 (13%). Three cases showed no response to treatment. In three cases, PP was discontinued prior to rituximab, and PP was not used at all in one case. Of note, although the average age (15.3 �� 2.6) in our series is higher than these reported cases, the outcomes are similar. A multicenter case series by Prytula et al. was not included in the review because information was obtained via survey, and repeat reporting of cases could not be ascertained.

In this series of 15 pediatric transplant patients, 40% attained complete remission, 27% attained partial remission and 33% had no response to rituximab [22]. Data on PP was not available. Table 2 Summary of the literature on use of rituximab in pediatric recurrent FSGS. Our series is unique Anacetrapib in that it is the largest pediatric cohort of recurrence of FSGS with deceased donor allografts treated at a single center that has been described in the literature. Hickson et al.