title: Combined use of rituximab and plasmapheresis pre-transplant increases post-transplant infections in renal transplant recipients with basiliximab induction therapy.
abstract: BACKGROUND
  We investigated the effect of combined use of rituximab (RTX) and plasmapheresis (PP) pre-transplant on post-transplant infection.
  
  
  METHODS
  A total of 196 patients undergoing living-donor kidney transplantation at Seoul St. Mary's Hospital, all of whom underwent basiliximab induction therapy, were included in the study. They were divided into 3 groups: RTX/PP/intravenous immune globulin (IVIG) (the RPI group; n = 53), RTX monotherapy (the RTX group; n = 14), and control (the CONT group; n = 129). We compared the post-transplant infections in the 3 groups.
  
  
  RESULTS
  The overall prevalence of infection was significantly higher, and the infection-free survival rate was lower, in the RPI group compared with the RTX or CONT groups (P < 0.05). A trend toward more severe bacterial infections was seen in the RPI group compared with the other groups, and fungal infections developed only in the RPI group. After anti-rejection therapy, a significantly higher rate of infection developed in the RPI group than in the other groups (P < 0.05). In addition, the RPI group was an independent risk factor for the development of infection.
  
  
  CONCLUSIONS
  Our results show that in the setting of basiliximab induction, the use of combined RTX and PP therapy pre-transplant significantly increases the risk for post-transplant infection.
authors.affiliation: Transplant Research Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea; Division of Nephrology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: B H
authors.initials: BH
authors.lastname: Chung
authors.forename: J T
authors.initials: JT
authors.lastname: Yun
authors.forename: S E
authors.initials: SE
authors.lastname: Ha
authors.forename: J I
authors.initials: JI
authors.lastname: Kim
authors.forename: I S
authors.initials: IS
authors.lastname: Moon
authors.forename: B S
authors.initials: BS
authors.lastname: Choi
authors.forename: C W
authors.initials: CW
authors.lastname: Park
authors.forename: Y S
authors.initials: YS
authors.lastname: Kim
authors.forename: C W
authors.initials: CW
authors.lastname: Yang
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects*; D001739:BK Virus; D000077552:Basiliximab; D003131:Combined Modality Therapy / Q000009:adverse effects; D003586:Cytomegalovirus Infections / Q000209:etiology; D018572:Disease-Free Survival; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006562:Herpes Zoster / Q000209:etiology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000009:adverse effects* / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D060828:Induction Chemotherapy; D016030:Kidney Transplantation / Q000379:methods*; D008172:Lung Diseases, Fungal / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis / Q000009:adverse effects*; D018410:Pneumonia, Bacterial / Q000209:etiology; D027601:Polyomavirus Infections / Q000209:etiology; D011300:Preoperative Care / Q000009:adverse effects; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D000069283:Rituximab; D019172:Transplantation Conditioning / Q000009:adverse effects*; D014412:Tumor Virus Infections / Q000209:etiology; D014552:Urinary Tract Infections / Q000209:etiology
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000069283:Rituximab; D000077552:Basiliximab
keywords: infectious complication; kidney transplantation; plasmapheresis; rituximab