Low-density lipoprotein apheresis for recurrent focal segmental glomerulosclerosis in pediatric kidney transplant recipients: a systematic review and meta-analysis.
Emily T Hayes, Debora Matossian, Annie B Wescott et al.
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In 30 seconds
This systematic review and descriptive meta-analysis assessed low-density lipoprotein apheresis (LDL-A) for recurrent focal segmental glomerulosclerosis in pediatric kidney transplant recipients. Eight studies contributed patient-level data for 25 children. At a median follow-up of 8 months (IQR 6-24 months), pooled complete and partial remission proportions were 0.36 (95% CI, 0.13-0.61) and 0.37 (95% CI, 0.14-0.62), respectively. Kidney-function measures showed a pattern of clinical improvement, but no significant remission differences were detected between LDL-A protocols. The authors note that the evidence is limited and suggest further study of early post-transplant use.
Key findings
- Pooled complete remission was 0.36 (95% CI, 0.13-0.61) at a median follow-up of 8 months (IQR 6-24 months).
- Pooled partial remission was 0.37 (95% CI, 0.14-0.62).
- Median serum albumin and eGFR increased, while UPCR decreased following LDL-A.
- No significant remission differences were detected between LDL-A protocols.
Why it matters
Recurrent FSGS can threaten kidney graft survival in children, and this review summarizes the limited patient-level evidence for LDL-A in that setting. The remission estimates and accompanying changes in laboratory measures suggest possible clinical benefit, while the broad confidence intervals and study limitations mean the findings should be interpreted cautiously rather than as definitive evidence of efficacy.
What to keep in mind
All included studies had moderate or high risk of bias. The small number of patients and variability in LDL-A protocols and prior treatments may contribute to heterogeneity and limit detection of differences.