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:: Volume 6, Issue 3 (9-2017) ::
Int J Med Invest 2017, 6(3): 109-115 Back to browse issues page
Treatment of acute antibody-mediated rejection using Rituximab
Saeid Amirkhanlou , Anna Rashedi , Mohammad Hadi Molseghi , Mahdi Babaei Hatkehlouei , Mohsen Nafar , Fatemeh Rezaghoulipoor , Arash Rezai Shahmirzadi *
Student Research Committee, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
Abstract:   (7348 Views)
Introduction: One of the optimal therapies for most of the end-stage renal disease (ESRD) patients is transplantation. Acute Antibody Mediated Rejection is one type of acute rejection in which antibodies are directed against donor specific human leukocyte antigen (HLA). Rituximab is one kind of the drugs used for AMR treatment based on elimination of circulating Ab. It is a chimeric monoclonal Ab which is specific for human B lymphocyte– restricted differentiation antigen (CD20). Concerning the incidence of AMR in transplantation, existence of resistance to usual AMR therapy and their poor outcomes, we decided to use Rituximab (RTX) in treatment of AMR and to study its outcomes. Material/Patients: All patients who underwent renal transplantation from 2009 to 2014 in Chamran and Labbafinejad centers enrolled. these patients further receiving conventional therapy AMR (tacrolimus + Cellcept + corticosteroids ± PP), were treated with one or two dosage of RTX 500mg and the graft`s response and the patient's response to RTX were studied. Results: After 5-11 months follow-up, patients’ survival was 100% and grafts survival was 77%. In 17 patients renal function improved which the average creatinine (Cr) in the first month after treatment was 1.6+/-0.5 (P<0.001) and the average Cr in 6 month was 1.5+/- 0.8 (P<0.001).Conclusion: In comparison with outcomes reported before in treatment of AMR, our study obtained excellent outcomes in patient and graft survival (100% and 77% respectively). Our findings suggest that the usage of RTX in the treatment of AMR at least in short and medium term may be effective.
Keywords: Rituximab, Renal Transplantation, Acute Antibody-Mediated Rejection
Full-Text [PDF 425 kb]   (2346 Downloads)    
Type of Study: case report | Subject: General
References
1. 1. Warren DS, Zachary AA, Sonnenday CJ, et al. Successful renal transplantation across simultaneous ABO incompatible and positive crossmatch barriers. Am J Transplant 2004;4:561-8. 2. Becker YT, Becker BN, Pirsch JD, Sollinger H. Rituximab as treatment for refractory kidney transplant rejection. Am J Transplant 2004;4:996-1001. 3. Montgomery RA, Simpkins CE, Zachary AA, et al. Anti-CD20 rescue therapy for kidneys undergoing antibody-mediated rejection. Am J Transplant 2004;4(Suppl 8):258. 4. Samaniego M, Zachary AA, Lucas D, et al. Early allograft outcomes in patients with antibody mediated rejection treated with rituximab: a single center experience. Am J Transplant 2002;2(Suppl 3):259. 5. Macklin PS, Morris PJ, Knight SR. A systematic review of the use of rituximab for the treatment of antibody-mediated renal transplant rejection. Transplant Rev (Orlando). 2017 Jan 24. pii: S0955-470X(16)30114-8. 6. Peng A, Vo A, Bunnapradist S, Toyoda M, Jordan S. Incidence and outcomes of treatment protocols for antibody-mediated rejection in highly sensitized patients transplanted using desensitization therapy. (Abstract)Am J Transplant and Transplantation 2006(World Transplant Congress 2006):259. 7. Melcher ML, Olson JL, Baxter-Lowe LA, Stock PG, Posselt M. Antibody-mediated rejection of a pancreas allograft. Am J Transplant 2006; 6:423-8. 8. Gubensek J, Buturovic-Ponikvar J, Kandus A, Arnol M, Lindic J, Kovac D, Rigler AA, Romozi K, Ponikvar R. Treatment of Antibody-Mediated Rejection After Kidney Transplantation - 10 Years' Experience With Apheresis at a Single Center. Ther Apher Dial. 2016 Jun;20(3):240-5. 9. Baran DA, Lubitz S, Alvi S, et al. Refractory humoral cardiac allograft rejection successfully treated with a single dose of rituximab. Transplant Proc 2004; 36:3164-6. 10. Faguer S, Kamar N, Guilbeaud-Frugier C, et al. Rituximab therapy for acute humoral rejection after kidney transplantation. Transplantation 2007; 83:1277-80. 11. Surendra M, Raju SB, Raju N, Chandragiri S, Mukku KK, Uppin MS. Rituximab in the treatment of refractory late acute antibody-mediated rejection: Our initial experience. Indian J Nephrol. 2016 Sep;26(5):317-321. 12. Stegall MD, Gloor J,Winters JL, Moore SB, DeGoey S. A comparison of plasmapheresis versus high-dose IVIg desensitization in renal allograft recipients with high levels of donor specific alloantibody. Am J Transplant 2006; 6:346-51. 13. Roll P, Palanichamy A, Kneitz C, Dorner T, Tony H. Regeneration of B cell subsets after transient B cell depletion using anti-CD20 antibodies in rheumatoid arthritis. Arthritis Rheum 2006; 54: 2377-86. 14. Sidner RA, Book BK, Agarwal A, Bearden CM, Vieira CA, Pescovitz M. In vivo human B-cell subset recovery after in vivo depletion with rituximab, anti-human CD20 monoclonal antibody. Hum Antibodies 2004; 13:55-62. 15. Lachmann N, Duerr M, Schönemann C, Pruß A, Budde K, Waiser J. Treatment of Antibody-Mediated Renal Allograft Rejection: Improving Step by Step. J Immunol Res. 2017;2017:6872046. 16. Garces JC, Giusti S, Staffeld-Coit C, Bohorquez H, Cohen AJ, Loss GE. Antibody-Mediated Rejection: A Review. Ochsner J. 2017 Spring;17(1):46-55. 17. Shapiro-Shelef M, Calame K. Plasma cell differentiation and multiple myeloma. Curr Opin Immunol 2004; 16:226-34. 18. Vieira CA, Agarwal A, Book BK, et al. Rituximab for reduction of anti-HLA antibodies in patients awaiting renal transplantation: 1. Safety, pharmacodynamics and pharmacokinetics. Transplantation 2004; 77:542-8. 19. Hogen R, DiNorcia J, Dhanireddy K. Antibody-mediated rejection: what is the clinical relevance? Curr Opin Organ Transplant. 2017 Apr;22(2):97-104. 20. Nin M, Coitiño R, Kurdian M, Orihuela L, Astesiano R, Garau M, López D, Rievas G, Rodriguez I, González-Martínez F, Noboa O. Acute Antibody-Mediated Rejection in Kidney Transplant Based on the 2013 Banff Criteria: Single-Center Experience in Uruguay. Transplant Proc. 2016 Mar;48(2):612-5.
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Amirkhanlou S, Rashedi A, Molseghi M H, Babaei Hatkehlouei M, Nafar M, Rezaghoulipoor F et al . Treatment of acute antibody-mediated rejection using Rituximab . Int J Med Invest 2017; 6 (3) :109-115
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Volume 6, Issue 3 (9-2017) Back to browse issues page
International Journal of Medical Investigation
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