title: B cells and immunoglobulin in ABO-incompatible renal transplant patients receiving rituximab and double filtration plasmapheresis.
abstract: OBJECTIVE
  The effect of rituximab on B cell and immunoglobulin production after therapeutic apheresis has not been studied in ABO-incompatible renal transplant patients.
  
  
  METHODS
  Twenty consecutive ABO-incompatible renal transplant patients receiving rituximab induction and double filtration plasmapheresis were enrolled; one case was excluded because of repeated plasmapheresis and immunoglobulin therapy (Incompatible group). The B cell count of the Incompatible group was compared to another group of 18 ABO-compatible renal transplant patients who were operated on during the same period (Compatible group). In the Incompatible group, the total IgM, IgG, and IgG1-4 subclasses after transplantation were compared to those before desensitization. Tacrolimus, mycophenolate mofetil, and steroids were used for both groups.
  
  
  RESULTS
  The B cell count of the Incompatible group was significantly lower than the Compatible group post-transplant from Month 1 to Month 11 only. The B cell count of the Compatible group also decreased for the first 6 months, suggesting that maintenance immunosuppressive agents suppress B cells. Total IgG and IgM levels after transplantation were significantly lower than before desensitization during the 24-month follow-up period. The post-transplant IgG3 level was significantly lower than before desensitization for only 3 months.
  
  
  CONCLUSIONS
  With the aid of tacrolimus and mycophenolate mofetil, rituximab resulted in sustained suppression of B cell count and total IgG and IgM. Among the IgG subclasses, IgG3 was less sensitive to rituximab.
authors.affiliation: Department of Surgery, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan.
authors.forename: Meng-Kun
authors.initials: MK
authors.lastname: Tsai
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan.
authors.forename: Ming-Shiou
authors.initials: MS
authors.lastname: Wu
authors.affiliation: Department of Surgery, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan.
authors.forename: Ching-Yao
authors.initials: CY
authors.lastname: Yang
authors.affiliation: Department of Surgery, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan.
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Lee
authors.affiliation: Department of Surgery, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan.
authors.forename: Chi-Chuan
authors.initials: CC
authors.lastname: Yeh
authors.affiliation: Department of Surgery, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan.
authors.forename: Rey-Heng
authors.initials: RH
authors.lastname: Hu
authors.affiliation: Department of Surgery, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan.
authors.forename: Po-Huang
authors.initials: PH
authors.lastname: Lee
authors.affiliation: Department of Surgery, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan. Electronic address: HSLai@ntu.edu.tw.
authors.forename: Hong-Shiee
authors.initials: HS
authors.lastname: Lai
mesh_terms: D000328:Adult; D001402:B-Lymphocytes / Q000166:cytology*; D001787:Blood Group Incompatibility; D005260:Female; D006085:Graft Survival; D006801:Humans; D007132:Immunoglobulin Isotypes / Q000097:blood*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives; D010956:Plasmapheresis; D012189:Retrospective Studies; D000069283:Rituximab / Q000627:therapeutic use*; D013256:Steroids / Q000627:therapeutic use; D016559:Tacrolimus; D013624:Taiwan
chemical_list: D007132:Immunoglobulin Isotypes; D007166:Immunosuppressive Agents; D013256:Steroids; D000069283:Rituximab; D009173:Mycophenolic Acid; D016559:Tacrolimus
keywords: B cells; immunosuppressants; renal transplantation; rituximab