Rasheed Abiodun Balogun

Multiple myeloma light chain cast nephropathy (LCCN) is often treated with plasma exchange (PLEX) or the anti‐CD38 monoclonal antibody, daratumumab. However, rigorous studies supporting these therapies for LCCN are limited. Using data from 25 U.S.‐based academic cancer centers, we conducted two target trials examining the association between early receipt of PLEX or early receipt of daratumumab and kidney recovery in patients with newly diagnosed LCCN. Kidney recovery was defined as being alive, not on kidney replacement therapy, and with an improvement of at least one stage of AKI severity, all assessed at 90 days. Secondary outcomes included kidney recovery at 60 and 180 days. Logistic regression with propensity score overlap weights was used to adjust for confounders. Of 549 eligible patients for the PLEX target trial, 158 (28.8%) received PLEX. There was no association between PLEX and kidney recovery at 90 days (OR 1.48, 95% CI: 0.96–2.30). However, in subgroup analyses, PLEX was associated with higher odds of kidney recovery at 90 days among patients with newly diagnosed multiple myeloma compared to those with relapsed disease, as well as higher odds of kidney recovery among those with Stage 3 versus Stage 1 or 2 AKI at the time of LCCN diagnosis. Of 474 patients eligible for the daratumumab target trial, 136 (28.7%) received daratumumab. Daratumumab was not associated with kidney recovery at 90 days (OR 1.46, 95% CI: 0.84–2.55). Thus, in this multicenter cohort study, neither PLEX nor daratumumab was associated with kidney recovery at 90 days.

Apheresis medicine comprises a group of extracorporeal therapies essential for the management of hematologic, renal, neurologic, immunologic, transplant‐related, oncologic, and critical care conditions. Advances in technology, expansion of evidence‐based indications, and integration into multidisciplinary care pathways have transformed apheresis from a technical service into a clinically complex subspecialty. We conducted a narrative review of published literature and international society documentation describing models for apheresis training, professional societies, quality assurance, and regulatory interaction across high‐income and resource‐limited settings. Sources included peer‐reviewed literature, international society guidelines, and policy documents published primarily between 2010 and 2026. Professional apheresis societies have emerged internationally to support education, quality assurance, guideline development, and workforce competency, frequently in collaboration with regulatory authorities. These societies function as scientific and educational bodies complementary to, rather than substitutive of, regulatory frameworks. Six core domains of society activity were identified: education and continuing professional development (CPD), quality and patient safety, guidelines and standards, workforce development, research and registries, and professional collaboration. Apheresis medicine has matured into a multidisciplinary clinical subspecialty requiring a dedicated professional infrastructure. International experience demonstrates that professional apheresis societies provide an evidence‐based mechanism to advance education, quality assurance, and patient safety while complementing regulatory oversight. These models are generalizable across healthcare systems at varying stages of development.

Recurrence of focal segmental glomerulosclerosis (FSGS) following kidney transplantation remains a significant cause of allograft loss. Much remains unknown about the efficacy of apheresis treatments and the factors that determine favorable treatment outcomes. This retrospective cohort study involved adult patients with pre‐transplant diagnosis of FSGS, who developed recurrent FSGS in the post‐transplant period over 6 years, from January 1, 2017, to December 31, 2022. Twenty patients with biopsy‐confirmed FSGS who received therapeutic plasma exchange (TPE) as part of their treatment regimen were included. Demographic data, transplant characteristics, procedure details, urine protein levels, and other relevant variables were retrieved. Data was compiled in a Microsoft Excel spreadsheet and analyzed using the Statistical Package for the Social Sciences (SPSS, IBM NY, 2023, version 29). A p ‐value of less than 0.05 was considered statistically significant. Data from 20 patients encompassing 169 TPE sessions were analyzed. Of these, 15 patients (75%) achieved remission of proteinuria, while 5 (25%) did not. The median time to remission was 6 months, and the median number of TPE was 7 (interquartile range [IQR] = 2–13). There was no significant difference in time to remission between patients with complete and partial remission. Receiving more than five TPE sessions (adjusted odds ratio [AOR] = 1.6 (1.01–2.46); p = 0.02) and having lower baseline proteinuria at treatment initiation (AOR = 1.9 (1.03–8.94); p = 0.01) were independent predictors of remission. The complication rate was 10.7%, with hypocalcemia being the most common, occurring in 5.9% of cases. One mortality was recorded during apheresis, yielding a procedure mortality rate of 0.6%. Initiating treatment at lower levels of proteinuria (i.e., earlier in the course of disease recurrence) appear to enhance the likelihood of remission. Our result suggests that a trial of therapy extending beyond the initial induction phase may be necessary to capture late‐responding patients. The procedure was generally well tolerated, with few reversible adverse events. However, vigilant monitoring remains essential for optimal management.

Background: Data on the epidemiology of acute kidney injury (AKI) in adults hospitalized with Lassa fever is limited. We investigated the rates and predictors of AKI and in-hospital mortality at a National Treatment Centre in Southwest Nigeria. Methods: This retrospective study included 482 adults with RT-PCR-confirmed Lassa fever admitted to the Federal Medical Centre, Owo, Ondo State, Nigeria, from January 2019 to December 2024. Predictors of AKI and in-hospital mortality were identified by multivariable logistic regression and Cox proportional hazards regression analyses. Results: Acute kidney injury prevalence was 21% (95% CI, 17.4%–24.9%). Overall, 48 patients (10.1%) died: 33 (32.7%) with AKI and 15 (4.0%) without AKI (OR 11.647; 95% CI, 6.001–22.604; P < .001). Independent predictors of AKI included male sex (P < .001), bleeding abnormalities (P = .044), diabetes (P = .029), elevated white blood cell count (P = .005), increased neutrophil count (P = .003), and elevated aspartate transaminase (P = .017). Predictors of in-hospital mortality were AKI (P = .033), oliguria (P = .045), mean arterial blood pressure (P = .001), hematuria (P = .015), and elevated monocyte count (P = .022). Kaplan–Meier analysis demonstrated significantly poorer survival in patients with AKI versus those without (mean survival 19.0 vs 29.7 days; P ≤ .001). Conclusions: Acute kidney injury complicates approximately one-fifth of RT-PCR-confirmed Lassa fever hospitalizations and is associated with an 11-fold increase in mortality. Male sex, bleeding, diabetes, leukocytosis, and elevated aspartate transaminase independently predict AKI, while oliguria, hematuria, blood pressure, and monocyte count predict death.

Background: Establishing a comprehensive apheresis medicine program in a resource‐constrained setting presents significant structural, financial, and logistical challenges. Despite the growing clinical importance of apheresis services globally, published experience from sub‐Saharan Africa remains sparse. This study describes the 5‐year operational experience of building and sustaining an Apheresis Medicine program at Next Hematology Medicare, a private hematology center in Lagos, Nigeria, including the challenges encountered, solutions implemented, and clinical outcomes achieved. Methods: A retrospective review of all apheresis procedures performed between May 2020 and December 2025 was conducted. Therapeutic apheresis procedures included automated red cell exchange transfusion (RCE), therapeutic plasma exchange (TPE) and leukocytapheresis. Donor apheresis procedures comprised single‐donor apheresis platelet collections for transfusion and stem cell collection (SCC) by donors. Data on patient demographics, clinical indications, procedural outcomes, and geographic distribution of platelet delivery were collected and analyzed. Results: A total of 2405 apheresis procedures were performed over the 5‐year period. Donor apheresis platelet (AP) collection was the most frequently performed procedure ( n = 1772; 73.7%), followed by RCE ( n = 617; 25.7%) as the most common therapeutic apheresis modality. TPE accounted for 12 procedures ( n = 12; 0.5%), while leukocytapheresis ( n = 2; < 0.1%) and SCC ( n = 1; < 0.1%) were performed infrequently. For AP, Sepsis/DIC was the leading transfusion indication ( n = 968; 54.6%). RCE was performed predominantly for patients with sickle cell anemia (SCA), with intractable recurrent vaso‐occlusive crises (VOC) being the most common indication ( n = 382; 61.9%). RCE significantly reduced hemoglobin S (HbS%) from 93.13% ± 12.4% to 18.74% ± 4.2% ( p < 0.001) and improved hematocrit from 16.34% ± 3.5% to 26.01% ± 4.2% ( p < 0.001). TPE was primarily indicated for neurological and transplant‐related conditions. Apheresis platelets were distributed nationally across all six geopolitical zones and internationally. Conclusion: A fully functional Apheresis Medicine program can be successfully established and sustained in a resource‐constrained low‐ and middle‐income country (LMIC) setting, delivering outcomes comparable to high‐income country benchmarks. RCE showed significant hematological benefits for patients with SCA, and donor apheresis platelet delivery extended care across all Nigerian geopolitical zones. The operational framework described here, addressing funding, infrastructure, staffing, licensing, and blood safety, provides a possibly replicable model for Apheresis Medicine program development across sub‐Saharan Africa.

Background: Therapeutic apheresis (TA) is an established treatment modality for hematologic, neurologic, and immunologic disorders, yet access remains severely limited in sub‐Saharan Africa. Donor apheresis, including platelet apheresis collection from healthy donors, represents an important complementary modality supporting blood product availability and national transfusion services. The Nigerian Society for Apheresis (NSFA) held its inaugural scientific meeting on February 6, 2026, representing a significant milestone in advancing apheresis services in West Africa. Methods: We present a comprehensive summary of seven oral presentations and three poster abstracts submitted to the inaugural NSFA meeting, representing multi‐center experiences from Lagos, southeastern Nigeria, and international collaborative programs. Results: Collectively, over 3800 therapeutic and donor apheresis procedures were reported across multiple centers over varying time periods. The most common procedures were apheresis platelets (73.7% of 2405 procedures at one center) and automated red cell exchange for sickle cell disease (25.7%). Therapeutic plasma exchange (TPE) was performed for neurological indications including Guillain‐Barré syndrome, myasthenia gravis, and neuromyelitis optica, as well as for renal transplant desensitization. A national survey revealed limited awareness among healthcare workers (mean knowledge score 5.10 ± 2.44/10), yet 88.4% expressed interest in hands‐on training. International collaboration through the ISN Sister Renal Centers program successfully established TPE capabilities at two centers in southwestern Nigeria. Common challenges included equipment availability, consumables supply, and cost barriers. Conclusions: These abstracts demonstrate growing therapeutic and donor apheresis capacity in Nigeria despite significant infrastructural and economic challenges. The establishment of NSFA and collaborative international programs represents a critical step toward expanding access to this essential therapy in West Africa.

Insights from the 12th Annual ASN Nephrology Fellow Survey

Kidney transplantation in Nigeria has witnessed remarkable advancements. Availability of suitable and willing living donors is one of the major factors leading to its success. The aim of this study was to identify and analyze the reasons for exclusion of potential living kidney donors in a transplant program at a tertiary hospital in Southeast Nigeria. This is important in order to improve donor screening, maximize the living donor pool and ensure donor safety. This was a retrospective study of kidney transplant register and medical records at the transplant clinic of Federal Medical Center Umuahia, Southeast Nigeria. Relevant clinical data of potential living kidney donors who presented for pre-donation evaluation over a period of 8 years were collated in excel sheet and analyzed using SPSS version 23.0. Tables, charts and graphs were used to illustrate some data. Pre-donation evaluation records of sixty four potential living donors were retrieved. Median age was 23 (IQR=19-39) years There were 62 males and 2 females with M:F ratio of 31:1. Majority were unskilled workers (83%) and unrelated to prospective recipients (61%). Among those related to the patients (39%), there were more second-degree relatives (22%) than first degree relatives (17%). Out of the 64 potential kidney donors, 13 (20%) eventually donated while 51(80%) did not. Factors that prevented eventual kidney donation included immunological incompatibility (32.8%), albuminuria (11%), hypertension (9%), financial motivation (9%), nephrolithiasis (4.7%), donor withdrawal from donation process (4.7%), Hepatitis B infection (3%), prediabetes (3%) and abnormal cardiac function (1.5%). The potential living donors evaluated were mostly young males that were unrelated to their potential recipients. Immunologic incompatibility was the leading cause of failure to donate a kidney; mainly from donor-recipient significant HLA mismatches.