Treatment of symptomatic transplant glomerulopathy with rituximab.
Kidney transplant glomerulopathy (TG) has a poor outcome as there are no known effective therapies. Therefore, we investigated whether rituximab therapy (RTx) could halt progression of established TG. Fourteen kidney-transplant patients (nine of whom were men), with median age of 54 (range: 30-74) years, of whom seven had biologic markers for HCV infection, underwent a kidney biopsy (KB) at 118 months post-transplant because of impaired allograft function, associated with albuminuria (95-13430 mg/day), within nephrotic-range albuminuria in seven patients. KBs showed no evidence of acute cellular rejection but showed TG. Donor-specific anti-HLA antibodies were present in six cases. When diagnosis of TG was made, patients were placed on rituximab therapy (RTx) (2-4 injections of 375 mg/m2 week), and other concurrent immunosuppression treatments were not modified. By last follow up post-RTx (30 months), seven (50%) patients had lost their kidney within 6-26 months and the other seven had stable creatinine (182 vs. 161 micromol/l; NS), and albuminuria had decreased from 2660 to 500 mg/day (P = 0.03). There was prolonged B-cell lymphopenia (from 71 to 0/mm3) whereas immunoglobulin G, A, M levels remained stable, and four patients (28.5%) experienced severe infectious complications. We conclude that long-term RTx in kidney-transplant patients with TG is associated with allograft function/stabilization in 50% of cases.
Rostaing
Lionel
L
Department of Nephrology, Dialysis and Multiorgan Transplantation, Toulouse University Hospital, CHU Rangueil, Toulouse Cédex, France. rostaing.l@chu-toulouse.fr
Guilbeau-Frugier
Céline
C
Fort
Marylise
M
Mekhlati
Louiza
L
Kamar
Nassim
N
D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000175:diagnosis; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D003449:Cryoglobulinemia / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007674:Kidney Diseases / Q000188:drug therapy* / Q000209:etiology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011507:Proteinuria / Q000628:therapy; D000069283:Rituximab; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab