title: Determination of rituximab dose according to immunologic risk in ABO-incompatible kidney transplantation.
abstract: The adequate rituximab (RTX) dosage in ABO-incompatible transplantation (ABO-IKT) remains undetermined. We used two kinds of RTX dosage groups [low RTX (100 mg/m(2)) and typical RTX (375 mg/m(2)) dosage groups] according to immunologic risks and investigated the change of B-cell, anti-ABO antibodies, and the clinical outcome in ABO-IKT according to the RTX dose. Fifteen patients with high immunologic risk [panel reactive antibody (PRA) > 50%, retransplant, AB to O transplant] were assigned to typical RTX group and 17 patients without risk were assigned to low RTX group. We compared the changes of B-cell, anti-ABO antibody titer, required number of plasmapheresis (PP), and the clinical outcome after transplantation between the two groups. After infusion of RTX, peripheral blood B-cell counts were successfully depleted to <1% in both groups. Before kidney transplantation (KT), the minimal number of PP to achieve the target titer (1:16) (2.6 ± 2.7 vs. 2.2 ± 2.5; p = 0.66) and the titer reduction rate of anti-ABO antibodies did not differ between the two groups (low RTX: 1.52 ± 1.21 vs. typical RTX: 1.53 ± 1.20, p = 0.94). After KT, anti-ABO antibody titer was suppressed less than 1:32 in both groups up to posttransplant 1 year. The allograft function and infectious complication did not differ between the two groups as well. In ABO-IKT, low RTX is comparable with typical RTX dosing with respect to B-cell depletion, antibody rebound suppression, the effect on clinical outcome in patients with low immunologic risk.
authors: Transplant Research Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors: Byung Ha
authors: BH
authors: Chung
authors: Yu Ah
authors: YA
authors: Hong
authors: In O
authors: IO
authors: Sun
authors: Shang Guo
authors: SG
authors: Piao
authors: Ji-Il
authors: JI
authors: Kim
authors: In Sung
authors: IS
authors: Moon
authors: Bum Soon
authors: BS
authors: Choi
authors: Cheol Whee
authors: CW
authors: Park
authors: Yong-Soo
authors: YS
authors: Kim
authors: Chul Woo
authors: CW
authors: Yang
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage*; D001402:B-Lymphocytes / Q000276:immunology*; D001787:Blood Group Incompatibility / Q000188:drug therapy / Q000276:immunology*; D003888:Desensitization, Immunologic / Q000379:methods*; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D016030:Kidney Transplantation / Q000276:immunology* / Q000379:methods; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D012306:Risk; D000069283:Rituximab; D014181:Transplantation Immunology
chemical_list: D000017:ABO Blood-Group System; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab