Efficacy of Low-Density Lipoprotein Apheresis in an Adult Case of Recurrent Focal Segmental Glomerulosclerosis Post-kidney Transplant

Recurrence of focal segmental glomerulosclerosis (FSGS) in the transplanted kidney has been reported in renal transplant cases. The management often involves therapeutic plasma exchange (TPE) and immunomodulatory therapies with a variable response. In patients with FSGS, dyslipidemia can contribute to irreversible renal injury. We present a 26-year-old man with recurrent FSGS in his second transplanted kidney which was controlled partially with aggressive TPE for over 3.5 years. He achieved complete remission following the completion of the low-density lipoprotein apheresis (LDL-A) protocol which consists of two procedures per week for three consecutive weeks, followed by one procedure per week for the 12 consecutive weeks (total of 18 procedures). He has been in remission for over four years after a single course of LDL-A. This report supports the use of LDL-A for recurrent FSGS post-kidney transplant in adults.