title: The effect of combination therapy with rituximab and intravenous immunoglobulin on the progression of chronic antibody mediated rejection in renal transplant recipients.
abstract: The treatment for chronic active antibody-mediated rejection (CAMR) remains controversial. We investigated the efficacy of rituximab (RTX) and intravenous immunoglobulin (IVIg) for CAMR. Eighteen patients with CAMR were treated with RTX (375 mg/m(2)) and IVIg (0.4 g/kg) for 4 days. The efficacy of RTX/IVIg combination therapy (RIT) was assessed by decline in estimated glomerular filtration rate per month (ΔeGFR) before and after RIT. Patients were divided into responder and nonresponder groups based on decrease and no decrease in ΔeGFR, respectively, and their clinical and histological characteristics were compared. Response rate to RIT was 66.7% (12/18), and overall ΔeGFR decreased significantly to 0.4 ± 1.7 mL·min(-1) ·1.73 m(-2) per month 6 months after RIT compared to that observed 6 months before RIT (1.8 ± 1.0, P < 0.05). Clinical and histological features between the 12 responders and the 6 nonresponders were not significantly different, but nonresponders had a significantly higher proteinuria levels at the time of RIT (2.5 ± 2.5 versus 7.0 ± 3.5 protein/creatinine (g/g), P < 0.001). The effect of the RIT on ΔeGFR had dissipated in all patients by 1 year post-RIT. Thus, RIT delayed CAMR progression, and baseline proteinuria level was a prognostic factor for response to RIT.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Gun Hee
authors.identifier: 0000-0003-3519-3060
authors.initials: GH
authors.lastname: An
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Jintak
authors.initials: J
authors.lastname: Yun
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea.
authors.forename: Yu Ah
authors.identifier: 0000-0001-7856-4955
authors.initials: YA
authors.lastname: Hong
authors.affiliation: Dialysis Department, National Research Center for Maternal and Child Health, Astana, Kazakhstan.
authors.forename: Marina
authors.initials: M
authors.lastname: Khvan
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea ; Transplant Research Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Byung Ha
authors.identifier: 0000-0003-0048-5717
authors.initials: BH
authors.lastname: Chung
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea ; Transplant Research Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Bum Soon
authors.identifier: 0000-0002-1412-9951
authors.initials: BS
authors.lastname: Choi
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea ; Transplant Research Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Cheol Whee
authors.initials: CW
authors.lastname: Park
authors.affiliation: Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Yeong Jin
authors.initials: YJ
authors.lastname: Choi
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea ; Transplant Research Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Yong-Soo
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea ; Transplant Research Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Yang
mesh_terms: D000328:Adult; D000906:Antibodies / Q000097:blood*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D002908:Chronic Disease; D018450:Disease Progression; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000097:blood / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000276:immunology / Q000473:pathology / Q000628:therapy; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D058846:Antibodies, Monoclonal, Murine-Derived; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D000069283:Rituximab
references.citation: Clin Transpl. 2010;:391-6
references.pmid: 21696056
references.citation: Transplant Proc. 2012 Jan;44(1):182-4
references.pmid: 22310610
references.citation: J Am Soc Nephrol. 2001 Mar;12(3):574-582
references.pmid: 11181806
references.citation: Ann Intern Med. 2006 Aug 15;145(4):247-54
references.pmid: 16908915
references.citation: Transplant Rev (Orlando). 2012 Oct;26(4):280-90
references.pmid: 22902496
references.citation: Am J Transplant. 2011 Jul;11(7):1359-67
references.pmid: 21668625
references.citation: Transpl Immunol. 2012 Oct;27(2-3):107-13
references.pmid: 22960786
references.citation: Am J Transplant. 2007 Jul;7(7):1743-52
references.pmid: 17564636
references.citation: Transpl Int. 2012 Nov;25(11):1165-73
references.pmid: 22897111
references.citation: Am J Transplant. 2009 Nov;9(11):2520-31
references.pmid: 19843030
references.citation: Transplantation. 2008 Nov 15;86(9):1214-21
references.pmid: 19005402
references.citation: Am J Transplant. 2008 Apr;8(4):753-60
references.pmid: 18294345
references.citation: Am J Transplant. 2004 Jan;4(1):124-9
references.pmid: 14678043
references.citation: Clin Transpl. 2009;:323-37
references.pmid: 20524294
references.citation: Clin Transpl. 2010;:353-62
references.pmid: 21696053
references.citation: Am J Transplant. 2008 Mar;8(3):492-6
references.pmid: 18294145
references.citation: Nephrol Dial Transplant. 2010 Apr;25(4):1300-6
references.pmid: 19934095
references.citation: Transplantation. 2009 Jun 27;87(12):1837-41
references.pmid: 19543061
references.citation: N Engl J Med. 2003 Dec 11;349(24):2326-33
references.pmid: 14668458
references.citation: Am J Transplant. 2006 Mar;6(3):459-66
references.pmid: 16468954
references.citation: Transplantation. 2004 Feb 27;77(4):542-8
references.pmid: 15084932
references.citation: Transplantation. 2005 Nov 15;80(9):1194-7
references.pmid: 16314785
references.citation: Transplantation. 2011 May 15;91(9):1010-8
references.pmid: 21403590
references.citation: Am J Transplant. 2007 Mar;7(3):518-26
references.pmid: 17352710
references.citation: Transpl Int. 2012 Sep;25(9):925-34
references.pmid: 22764746
references.citation: Nat Clin Pract Nephrol. 2006 Apr;2(4):221-30
references.pmid: 16932428
references.citation: J Am Soc Nephrol. 2009 Oct;20(10):2260-8
references.pmid: 19729438
references.citation: Transplantation. 2013 Jul 27;96(2):121-30
references.pmid: 23435457
references.citation: Am J Transplant. 2007 Mar;7(3):618-25
references.pmid: 17217438
references.citation: Nat Rev Immunol. 2009 Mar;9(3):185-94
references.pmid: 19240757