title: Rituximab-Related Late-Onset Neutropenia in Kidney Transplant Recipients Treated for Antibody-Mediated Acute Rejection.
abstract: OBJECTIVE
  Kidney transplant is a new area for use of rituximab, which is being used to treat acute antibody-mediated rejection or as an induction agent in ABO- or HLA-incompatible grafts. We report on late-onset neutropenia in rituximab-treated kidney transplant recipients with antibody-mediated rejection.
  
  
  METHODS
  This observational prospective study was performed on kidney transplant recipients with clinically suspicious or biopsy-proven antibody-mediated rejection treated with plasmapheresis plus intravenous immunoglobulin with (cases) or without (controls) rituximab.
  
  
  RESULTS
  Compared with none of the controls, 4 of 6 patients (66.7%) in the rituximab-treated group experienced late-onset neutropenia 35 to 93 days after the last dose of rituximab. The course of neutropenia was complicated by endocarditis in 1 patient, resulting in his death just because of a lack of valvular surgery.
  
  
  CONCLUSIONS
  Increased use of rituximab to treat antibody-mediated rejection among kidney transplant recipients requires attention to its late-onset adverse event, neutropenia. Although asymptomatic in some patients, kidney transplant recipients treated concomitantly with plasmapheresis and mycophenolate mofetil are predisposed to hypogammaglobulinemia, and monitoring of patients for infections is required.
authors: From the Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
authors: Fatemeh
authors: F
authors: Ahmadi
authors: Simin
authors: S
authors: Dashti-Khavidaki
authors: Mohammad-Reza
authors: MR
authors: Khatami
authors: Mahboob
authors: M
authors: Lessan-Pezeshki
authors: Hossein
authors: H
authors: Khalili
authors: Malihe
authors: M
authors: Khosravi
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D010956:Plasmapheresis; D011446:Prospective Studies; D012307:Risk Factors; D000069283:Rituximab / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D000069283:Rituximab