title: A single low-fixed dose of rituximab to salvage renal transplants from refractory antibody-mediated rejection.
abstract: Rituximab may improve graft survival in renal acute antibody-mediated rejection (AMR), but data confirming efficacy and optimal dosing is lacking. High-dose regimens may be associated with significant rates of infective complications. We therefore conducted a pilot study of a single low-fixed dose (500 mg) of rituximab in seven consecutive patients with AMR resistant to standard therapy. After a mean follow-up of 21 months (range, 9.5-33 months), graft and patient survival were 100% with serum creatinine levels significantly lower than peak rejection levels (171+/-73 micromol/L vs. 559+/-358 micromol/L, P=0.028). B cells were undetectable in all patients for more than or equal to 6 months and in six of seven patients for more than or equal to 12 months after rituximab. Three patients encountered a significant infective complication including cytomegalovirus reactivation, viral pneumonia, and polyoma viral nephropathy. All have since resolved. A single low-fixed dose of rituximab may help improve graft survival in AMR and offers the potential advantage of reduced infective complications.
authors.affiliation: Department of Nephrology, Monash Medical Centre, Clayton, Australia. bill.mulley@southernhealth.org.au
authors.forename: William R
authors.initials: WR
authors.lastname: Mulley
authors.forename: Fiona J
authors.initials: FJ
authors.lastname: Hudson
authors.forename: Brian D
authors.initials: BD
authors.lastname: Tait
authors.forename: Alison M
authors.initials: AM
authors.lastname: Skene
authors.forename: John P
authors.initials: JP
authors.lastname: Dowling
authors.forename: Peter G
authors.initials: PG
authors.lastname: Kerr
authors.forename: John
authors.initials: J
authors.lastname: Kanellis
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived; D000917:Antibody Formation / Q000187:drug effects*; D001402:B-Lymphocytes / Q000187:drug effects / Q000276:immunology; D003404:Creatinine / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy* / Q000276:immunology; D006085:Graft Survival / Q000187:drug effects* / Q000276:immunology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010951:Plasma Exchange; D000069283:Rituximab; D016879:Salvage Therapy; D013997:Time Factors; D016896:Treatment Outcome; D014777:Virus Diseases / Q000276:immunology / Q000517:prevention & control
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D016756:Immunoglobulins, Intravenous; D000069283:Rituximab; D003404:Creatinine