WCN25-4225 POST TRANSPLANT BLOOD PRESSURE CHANGES AND ITS CORRELATES

Treatment & outcome Initial treatment involved 3 dosages of pulse methylprednisolone (MPS), daily PLEX for 5 sessions followed by one dose of rituximab (375 mg/m2) and increased immunosuppression (Tacrolimus level 9-10ng/ml).PEX was tapered to alternate days over two weeks & remission was achieved after 3-4 sessions and PEX was tapered and stopped over 12 sessions.The FSGS recurred again within one month of stopping PEX [Figure 1].The second recurrence was managed with six daily PEX and one dose of rituximab.PEX was tapered to twice weekly over 8 weeks, weekly for 4 weeks & then monthly twice, resulting in sustained remission.PLEX sessions were subsequently tapered once a month, resulting in sustained remission for >18 weeks.Discussion Although various treatment options including plasmapheresis (PLEX), immunoadsorption, rituximab, and increased doses of immunosuppressants are being used (2), standard guidelines for treatment and monitoring are lacking.Our case highlights the importance of frequent post-remission monitoring to detect early relapse, prompt intervention contributed to maintaining the normal eGFR & achieving sustained remission.We employed a gradual tapering of PEX over several months whichsupportedprolonged remission & better graft survival.Conclusions: Frequent monitoring for relapse especially after initial remission, along with a gradual tapering of PEX over an extended period may facilitate sustained remission and improved graft survival in recurrent FSGS post-transplant.