Application of rituximab to hepatitis C-positive, ABO-incompatible renal transplantation.
A safety issue has been noted in applying rituximab to renal transplant patients with HCV infection, as a hepatitis C virus (HCV) flare-up and lethal cholestatic hepatitis C occurred in a renal transplant patient treated with rituximab for lymphoproliferative disorder. As double-filtration plasmapheresis (DFPP) and cyclosporine were reported to reduce hepatitis C viremia, we performed ABO-incompatible renal transplantation in two patients with positive HCV RNA by using rituximab, DFPP and cyclosporine-based immunosuppressant. The HCV RNA level was 3.3 x 10(5) IU/mL for Case 1 and 1.2 x 10(3) IU/mL for Case 2 before DFPP. After DFPP and renal transplantation, Case 1 had stable ALT levels and a transient decrease in HCV RNA to 7.9 x 10(4) IU/mL at 1 month followed by a gradual increase to 7.6 x 10(6) at 12 months, but Case 2 had a dramatic and persistent elevation of HCV RNA to 7.7 x 10(6) from 1 week to 12 months accompanied by elevated ALT levels. The serum creatinine levels were 1.5 mg/dL for Case 1 and 1.9 mg/dL for Case 2 at 12 months. Although cholestatic hepatitis C did not occur in our patients, who received rituximab for ABO-incompatible renal transplantation, the antiviral effect of cyclosporine and DFPP did not seem evident.
Tsai
Meng-Kun
MK
Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Yang
Ching-Yao
CY
Wu
Ming-Shiou
MS
Lee
Po-Huang
PH
D000017:ABO Blood-Group System; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D003131:Combined Modality Therapy; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use; D016174:Hepacivirus / Q000235:genetics; D006509:Hepatitis B / Q000188:drug therapy; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D012367:RNA, Viral / Q000032:analysis; D000069283:Rituximab
D000017:ABO Blood-Group System; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D012367:RNA, Viral; D000069283:Rituximab; D016572:Cyclosporine; D003404:Creatinine; D000410:Alanine Transaminase