title: Infectious complications associated with the use of rituximab for ABO-incompatible and positive cross-match renal transplant recipients.
abstract: Immunosuppressive protocols for ABO-incompatible (ABOI) and positive cross-match (PCM) solid organ transplant (SOT) recipients have included the use of rituximab (RTX). Infectious complications (IC) have been reported after the use of RTX for other indications, but have not been well studied in the SOT population. We performed a retrospective review of IC occurring within six months of ABOI and PCM renal transplantation (RT) in recipients receiving RTX. Medical records were reviewed for bloodstream, lung, gastrointestinal tract, allograft, or soft tissue infection. Between July 2001 and December 2004, 34 ABOI or PCM RT were performed at University of Illinois at Chicago, 25 of which received RTX with plasmapheresis and antithymocyte globulin (ATG) (eight ABOI and 17 PCM). Among the RTX recipients, the rate of IC was 48% compared with 11% among historical controls who did not receive RTX (p = 0.107). There were 21 episodes of IC in 13 patients including skin and soft tissue infection (8), bloodstream infection (5), esophagitis (3), peritonitis (3), pneumonia (1), and colitis (1). There was no difference in the rate of rejection, graft survival or patient survival between the two groups. These data suggest that there is a trend toward an increased rate of IC with RTX therapy in ABOI and PCM RT recipients.
authors.affiliation: Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL 60612-7230, USA. sgrim@uic.edu
authors.forename: Shellee A
authors.initials: SA
authors.lastname: Grim
authors.forename: Thuy
authors.initials: T
authors.lastname: Pham
authors.forename: James
authors.initials: J
authors.lastname: Thielke
authors.forename: Howard
authors.initials: H
authors.lastname: Sankary
authors.forename: Jose
authors.initials: J
authors.lastname: Oberholzer
authors.forename: Enrico
authors.initials: E
authors.lastname: Benedetti
authors.forename: Nina M
authors.initials: NM
authors.lastname: Clark
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D058846:Antibodies, Monoclonal, Murine-Derived; D001788:Blood Grouping and Crossmatching; D003428:Cross Infection / Q000276:immunology*; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects*; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000069283:Rituximab
chemical_list: D000017:ABO Blood-Group System; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab