Rituximab therapy for acute humoral rejection after kidney transplantation

• Published in: Transplantation Vol. 83; no. 9; pp. 1277 - 1280
• Main Authors: FAGUER, Stanislas, KAMAR, Nassim, DURAND, Dominique, ROSTAING, Lionel, GUILBEAUD-FRUGIER, Céline, FORT, Marylise, MODESTO, Anne, MARI, Arnaud, RIBES, David, COINTAULT, Olivier, LAVAYSSIERE, Laurence, GUITARD, Joelle
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 15-05-2007
• Subjects: Acute Disease; Adult; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Murine-Derived; Antibody Formation; Biological and medical sciences; Creatine - blood; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Rejection - blood; Graft Rejection - drug therapy; Graft Rejection - etiology; Graft Rejection - physiopathology; Humans; Immunologic Factors - therapeutic use; Immunosuppressive Agents - therapeutic use; Infection - etiology; Isoantibodies - blood; Kidney - physiopathology; Kidney Failure, Chronic - etiology; Kidney Transplantation - adverse effects; Male; Medical sciences; Middle Aged; Mycophenolic Acid - analogs & derivatives; Mycophenolic Acid - therapeutic use; Pilot Projects; Plasma Exchange; Rituximab; Steroids - therapeutic use; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tacrolimus - therapeutic use; Tissue Donors; Tissue, organ and graft immunology; Treatment Outcome; Graft(material); Therapy; Acute; Rituximab; Monoclonal antibody; Homotransplantation; Kidney; Immunomodulator; Rejection; Treatment; Urinary system; Surgery; Immunotherapy; Anticytokine; Graft; Immunosuppressive agent; Humoral immunity; Kidney transplantation
• ISSN: 0041-1337; 1534-6080
• DOI: 10.1097/01.tp.0000261113.30757.d1

A pilot study was performed on eight consecutive renal-transplant (RT) patients presenting with acute humoral rejection (AHR) to assess the efficacy of monoclonal anti-B cell antibodies, such as rituximab (375 mg/m weekly) for 3 to 5 consecutive weeks, in addition to plasma exchange (PE), steroids, mycophenolate mofetil, and tacrolimus. AHR was associated with increased serum creatinine, the appearance of donor-specific alloantibodies (DSA), and the presence of C4d in a transplant biopsy. After a follow-up of 10 months (range 7-23), patient and graft survivals were 100% and 75%, respectively. Renal function improved in six cases in which serum creatinine decreased from 297+/-140 to 156+/-53 micromol/L (P=0.015); graft loss occurred in two cases; and four patients had infectious complications. At last follow-up, DSA had disappeared or decreased in four cases. Rituximab therapy, in addition to PE, might be of benefit for RT patients presenting with AHR.