PMID- 22088448
OWN - NLM
STAT- MEDLINE
DCOM- 20120504
LR  - 20151119
IS  - 2542-5641 (Electronic)
IS  - 0366-6999 (Linking)
VI  - 124
IP  - 13
DP  - 2011 Jul 5
TI  - Rituximab induction therapy in highly sensitized kidney transplant recipients.
PG  - 1928-32
AB  - BACKGROUND: The number of highly sensitized patients is rising, and sensitization 
      can lead to renal transplant failure. The present study aimed to investigate the 
      safety and efficacy of renal transplantation following induction therapy with 
      rituximab in highly sensitized kidney transplant recipients. METHODS: Seven 
      highly sensitized kidney transplant recipients who underwent rituximab therapy 
      from December 2008 to December 2009 were retrospectively analyzed. There were 3 
      men and 4 women, with a mean age of 38.5 years (range, 21-47 years). The duration 
      of hemodialysis was 3-12 months, with a mean duration of 11 months. For 4 
      patients, this was the second transplant; the previous graft survival time was 
      2-11 years, with a mean survival time of 5.8 years. All the female recipients had 
      history of multiple pregnancies, and all patients had previously received blood 
      transfusions. All donors were men, with a mean age of 32.5 years (range, 25-37 
      years). In 2 of the 7 patients, both class I and class II of panel reactive 
      antibody were high; the remaining 5 patients showed either high in class I or in 
      class II of panel reactive antibody. The mean panel reactive antibody value was 
      31% for class I and 51% for class II respectively. The donors and the recipients 
      had the same blood type, with low lymphocyte cytotoxicity ranging from 2% to 5%. 
      The human leukocyte antigen (HLA) mismatch numbers were from 2 to 4. All patients 
      received tacrolimus (0.1 mg x kg(-1) x d(-1)) and mycophenolate mofetil (750 mg 
      twice per day) orally 3 days prior to surgery. All patients received a single 
      dose of 600 mg rituximab (375 mg/m(2)) infusion on the day before surgery and 
      polyclonal antibody (antithymocyte globulin) on the day of surgery. Postoperative 
      creatinine, creatinine clearance rate, and occurrence of rejection by 
      pathological biopsy confirmation were monitored. RESULTS: No patient had delayed 
      graft function after surgery. Two patients had acute rejection, one on day 7 and 
      the other on day 13 post-surgery. Diagnosis of acute rejections was based on the 
      clinical assessments and pathological biopsy results. According to the Banff 07 
      classification of renal allograft pathology, one of the patients was Ia and the 
      other was IIa; the C4d staining was negative in both patients. One patient 
      received methylprednisolone plus cyclophosphamide and the other received 
      antithymocyte globulin (ATG) therapy, both leading to successful reversion of the 
      acute rejection. All patients were discharged postoperatively and all had normal 
      renal function during the 7th to 12th month follow-up. Pulmonary infection 
      occurred in 1 patient 4 months after surgery and was successfully cured. 
      CONCLUSION: Rituximab induction therapy can reduce the occurrence of 
      postoperative humoral rejection in highly sensitized renal transplant recipients, 
      suggesting that kidney transplantation may be safe and effective for these 
      patients.
FAU - Yin, Hang
AU  - Yin H
AD  - Kidney Transplantation Program, Department of Urology, Beijing Chao-Yang 
      Hospital, Capital Medical University, Beijing 100020, China.
FAU - Wan, Hao
AU  - Wan H
FAU - Hu, Xiao-peng
AU  - Hu XP
FAU - Li, Xiao-bei
AU  - Li XB
FAU - Wang, Wei
AU  - Wang W
FAU - Liu, Hang
AU  - Liu H
FAU - Ren, Liang
AU  - Ren L
FAU - Zhang, Xiao-dong
AU  - Zhang XD
LA  - eng
PT  - Journal Article
PL  - China
TA  - Chin Med J (Engl)
JT  - Chinese medical journal
JID - 7513795
RN  - 0 (Antibodies, Monoclonal, Murine-Derived)
RN  - 0 (Immunosuppressive Agents)
RN  - 4F4X42SYQ6 (Rituximab)
SB  - IM
MH  - Adult
MH  - Antibodies, Monoclonal, Murine-Derived/*therapeutic use
MH  - Female
MH  - Graft Survival/drug effects
MH  - Humans
MH  - Immunosuppressive Agents/*therapeutic use
MH  - Kidney Transplantation/adverse effects/*immunology/*methods
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Rituximab
MH  - Young Adult
EDAT- 2011/11/18 06:00
MHDA- 2012/05/05 06:00
CRDT- 2011/11/18 06:00
PHST- 2011/11/18 06:00 [entrez]
PHST- 2011/11/18 06:00 [pubmed]
PHST- 2012/05/05 06:00 [medline]
PST - ppublish
SO  - Chin Med J (Engl). 2011 Jul 5;124(13):1928-32.