Use of anti-CD20 antibody in the treatment of post-transplant glomerulonephritis.
Post-transplant glomerulonephritis (PTGN) accounts for 4-10% of late graft loss. Six consecutive patients who developed PTGN 3-72 months post-transplant presented to our center with deteriorating kidney function and proteinuria. Three had focal segmental glomerulosclerosis; one had membranoproliferative glomerulonephritis Type 1; one recurrent membranous nephropathy; and one recurrent immunoglobin A nephropathy. All six were treated with an aggressive immunosuppression regimen including rituximab, pulse steroids and/or maximization of mycophenolic acid and calcineurin inhibitor therapy. Four of the six patients received plasma exchange. The patients were followed for a minimum of nine months after treatment. Proteinuria decreased from 7.2 ± 4.4 to 1.4 ± 1.5g (p = 0.04), while mean estimated glomerular filtration rate was 31.2 ± 13.1 and 42.5 ± 21.7 mL/min (p = 0.07) at nine months. No adverse events were noted. These observations suggest that immune modulating therapy may be of benefit in the treatment of PTGN.
Damodar
Amar
A
Erie County Medical Center, State University of New York, Buffalo, NY, USA.
Mustafa
Reem
R
Bhatnagar
Jyotsna
J
Panesar
Mandip
M
Gundroo
Aijaz
A
Zachariah
Mareena
M
Blessios
George
G
Tornatore
Kathleen
K
Weber-Shrikant
Edit
E
Venuto
Rocco
R
D000888:Antibodies, Anti-Idiotypic / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D018951:Antigens, CD20 / Q000276:immunology; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D005921:Glomerulonephritis / Q000209:etiology / Q000276:immunology / Q000628:therapy*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D011183:Postoperative Complications; D011379:Prognosis; D011507:Proteinuria / Q000209:etiology / Q000276:immunology / Q000628:therapy; D012307:Risk Factors; D000069283:Rituximab; D015996:Survival Rate
D000888:Antibodies, Anti-Idiotypic; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D007155:Immunologic Factors; D000069283:Rituximab