Sequential blood level monitoring of basiliximab during multisession plasmapheresis in a kidney transplant recipient.
Basiliximab, a chimeric monoclonal antibody against the alpha chain of the interleukin-2 receptor (IL-2R) has been used in renal transplant patients. We monitored sequential blood concentrations of basiliximab in a patient who received a kidney transplant with basiliximab-based immunosuppression together with multiple sessions of plasmapheresis. A 34-year-old man received a living-related kidney transplant with induction immunosuppression including tacrolimus, mycophenolate, methylprednisolone, and basiliximab. Severe antibody-mediated acute rejection lead to a requirement for hemodialysis. Deoxyspergualin was administered for 10 days at a daily dose of 5 mg/kg combined with eight sessions of double filtration plasmapheresis (DFPP). After treatment, the serum creatinine returned to 0.95 mg/dL, and there were no major complications or infections. Sequential basiliximab blood levels of the patient were monitored following transplantation. The serum basiliximab concentration decreased by 72.4% after five consecutive DFPPs, and by 87.6% after eight DFPP sessions. The elimination rate of basiliximab (DeltaBLX) was 6.1% before DFPP, but increased over eight DFPPs to 20.5%. Serum basiliximab concentrations declined to 0.16 microg/mL on day 33, which is below the IL-2R saturation concentration (0.2 microg/mL). Multiple sessions of plasmapheresis using DFPP enhanced the elimination of serum basiliximab at an average elimination rate of 19.1%. In the patient reported on here, the serum basiliximab concentration fell to below the IL-2R saturation level (0.2 microg/mL) within 1 month of living-related kidney transplantation. We recommend that additional basiliximab infusions be considered for cases undergoing more than three plasmapheresis sessions.
Nojima
M
M
Department of Urology, Hyogo College of Medicine, Nishinomiya, Japan. nojimam@hyo-med.ac.jp
Yoshimoto
T
T
Nakao
A
A
Itahana
R
R
Kyo
M
M
Hashimoto
M
M
Shima
H
H
D000208:Acute Disease; D000328:Adult; D000911:Antibodies, Monoclonal / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use; D000077552:Basiliximab; D004359:Drug Therapy, Combination; D006084:Graft Rejection / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D010956:Plasmapheresis; D011993:Recombinant Fusion Proteins / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use; D006435:Renal Dialysis
D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab