Rituximab therapy for Epstein-Barr virus-related chronic hepatitis following living donor kidney transplantation.
A patient who underwent living donor kidney transplantation was infected with Epstein-Barr virus (EBV) that resulted in persistent EBV infection and EBV-associated chronic hepatitis, determined by abnormally elevated anti-EBV antibody titers and high frequency of EBV-infected B lymphocytes. Despite decreases in immunosuppressant doses, persistent EBV infection and chronic hepatitis persisted for several years. Therapy using anti-CD20 monoclonal antibody (rituximab) virtually eliminated peripheral B lymphocytes and EBV-encoded small RNA 1 (EBER-1)-positive cells. Moreover, hepatic enzyme levels normalized and histological findings indicated marked improvement in hepatic inflammation. Although peripheral CD20(+) B lymphocyte and EBER-1-positive cell levels began to increase 4 months after the end of therapy, the number of EBER-1-positive cells remained very low, and liver function test results remained within normal ranges. The present case illustrates the significance of early diagnosis, monitoring of viral load, and vigorous management of EBV-related disorders associated with organ transplantation.
Ohta
Kazuhide
K
Department of Pediatrics, Graduate School of Medical Science, Kanazawa University, Ishikawa 920-8641, Japan. kohta@ped.m.kanazawa-u.ac.jp
Shimizu
Masaki
M
Nakai
Akiko
A
Toma
Tomoko
T
Kasahara
Yoshihito
Y
Arii
Chihiro
C
Yachie
Akihiro
A
Kawamura
Takeshi
T
Aikawa
Atsushi
A
Hasegawa
Akira
A
Sato
Kazutaka
K
Yokoyama
Hitoshi
H
Ishikawa
Isao
I
Koizumi
Shoichi
S
D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D020031:Epstein-Barr Virus Infections / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006521:Hepatitis, Chronic / Q000188:drug therapy* / Q000473:pathology; D006525:Hepatitis, Viral, Human / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008099:Liver / Q000473:pathology; D019520:Living Donors; D009395:Nephritis, Interstitial / Q000601:surgery; D011183:Postoperative Complications / Q000188:drug therapy*; D000069283:Rituximab
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab