Incidence and predictive factors for infectious disease after rituximab therapy in kidney-transplant patients.
Rituximab off-label use includes organ transplantation. We review the occurrence of infectious disease and its outcome after rituximab therapy. Between April 2004 and August 2008, 77 kidney-transplant patients received rituximab therapy [2-8 courses (median 4) of 375 mg/m2 each] for various reasons. Their results were compared with a control group (n=902) who had received no rituximab. After a median follow-up of 16.5 (1-55) months for rituximab patients and 60.9 (1.25-142.7) months for control patients, the incidence of infectious disease was 45.45% and 53.9% (ns), respectively. The incidence of bacterial infection was similar between the two groups, whereas the viral-infection rate was significantly lower, and the rate of fungal infection was significantly higher in the rituximab group. Nine out of 77 patients (11.68%) died after rituximab therapy, of which seven deaths (9.09%) were related to an infectious disease, compared to 1.55% in the controls (p=0.0007). In the whole population, the independent predictive factors for infection-induced death were the combined use of rituximab and antithymocyte-globulin given for induction or anti-rejection therapy, recipient age, and bacterial and fungal infections. After kidney transplantation, the use of rituximab is associated with a high risk of infectious disease and death related to infectious disease.
Kamar
N
N
Department of Nephrology, Dialysis and Multi-Organ Transplantation, INSERM U858, CHU Rangueil, Toulouse, France. kamar.n@chu-toulouse.fr
Milioto
O
O
Puissant-Lubrano
B
B
Esposito
L
L
Pierre
M C
MC
Mohamed
A Ould
AO
Lavayssière
L
L
Cointault
O
O
Ribes
D
D
Cardeau
I
I
Nogier
M B
MB
Durand
D
D
Abbal
M
M
Blancher
A
A
Rostaing
L
L
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D001424:Bacterial Infections / Q000209:etiology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007239:Infections / Q000209:etiology* / Q000401:mortality; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology; D012307:Risk Factors; D000069283:Rituximab; D012449:Safety; D014777:Virus Diseases / Q000209:etiology; D055815:Young Adult
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D000069283:Rituximab