Combined use of rituximab and plasmapheresis pre-transplant increases post-transplant infections in renal transplant recipients with basiliximab induction therapy

Introduction 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 inductio...

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Published in:	Transplant infectious disease Vol. 15; no. 6; pp. 559 - 568
Main Authors:	Chung, B.H., Yun, J.T., Ha, S.E., Kim, J.I., Moon, I.S., Choi, B.S., Park, C.W., Kim, Y.S., Yang, C.W.
Format:	Journal Article
Language:	English
Published:	Denmark Blackwell Publishing Ltd 01-12-2013 Wiley Subscription Services, Inc
Subjects:	Adult Antibodies, Monoclonal - therapeutic use Antibodies, Monoclonal, Murine-Derived - adverse effects BK Virus Combined Modality Therapy - adverse effects Cytomegalovirus Infections - etiology Disease-Free Survival Female Graft Rejection - prevention & control Herpes Zoster - etiology Humans Immunoglobulins, Intravenous - therapeutic use Immunologic Factors - adverse effects Immunologic Factors - therapeutic use Immunosuppressive Agents - therapeutic use Induction Chemotherapy infectious complication kidney transplantation Kidney Transplantation - methods Lung Diseases, Fungal - etiology Male Middle Aged plasmapheresis Plasmapheresis - adverse effects Pneumonia, Bacterial - etiology Polyomavirus Infections - etiology Preoperative Care - adverse effects Recombinant Fusion Proteins - therapeutic use Retrospective Studies Rituximab Transplantation Conditioning - adverse effects Tumor Virus Infections - etiology Urinary Tract Infections - etiology infectious complication plasmapheresis rituximab kidney transplantation
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Summary:	Introduction 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. Conclusion 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.
Bibliography:	Korea Healthcare Technology R&D Project - No. A092258 ArticleID:TID12135 Welfare & Family Affairs istex:0AFB0609A8E3200D23A771E7ADB179852DC8578D Ministry for Health ark:/67375/WNG-XP995741-S Republic of Korea ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1398-2273 1399-3062
DOI:	10.1111/tid.12135