Rituximab therapy for acute humoral rejection after kidney transplantation.
A pilot study was performed on eight consecutive renal-transplant (RT) patients presenting with acute humoral rejection (AHR) to assess the efficacy of monoclonal anti-B cell antibodies, such as rituximab (375 mg/m weekly) for 3 to 5 consecutive weeks, in addition to plasma exchange (PE), steroids, mycophenolate mofetil, and tacrolimus. AHR was associated with increased serum creatinine, the appearance of donor-specific alloantibodies (DSA), and the presence of C4d in a transplant biopsy. After a follow-up of 10 months (range 7-23), patient and graft survivals were 100% and 75%, respectively. Renal function improved in six cases in which serum creatinine decreased from 297+/-140 to 156+/-53 micromol/L (P=0.015); graft loss occurred in two cases; and four patients had infectious complications. At last follow-up, DSA had disappeared or decreased in four cases. Rituximab therapy, in addition to PE, might be of benefit for RT patients presenting with AHR.
Faguer
Stanislas
S
Department of Nephrology, Dialysis and Multiorgan Transplantation, University Hospital, CHU Rangueil, Toulouse, France.
Kamar
Nassim
N
Guilbeaud-Frugier
Céline
C
Fort
Marylise
M
Modesto
Anne
A
Mari
Arnaud
A
Ribes
David
D
Cointault
Olivier
O
Lavayssière
Laurence
L
Guitard
Joelle
J
Durand
Dominique
D
Rostaing
Lionel
L
D000208:Acute Disease; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D000917:Antibody Formation; D003401:Creatine / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007239:Infections / Q000209:etiology; D007518:Isoantibodies / Q000097:blood; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000209:etiology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010865:Pilot Projects; D010951:Plasma Exchange; D000069283:Rituximab; D013256:Steroids / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use; D014019:Tissue Donors; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D013256:Steroids; D000069283:Rituximab; D009173:Mycophenolic Acid; D003401:Creatine; D016559:Tacrolimus