Analysis of Risk Factors for Infusion-Related Reactions Following Rituximab Administration in Patients with Desensitization before Renal Transplantation

Abstract

Infusion-related reactions (IRRs) are the major side effects of rituximab administration. Although several studies have reported predictive markers for IRRs in patients with malignancies, there are no such reports for patients without malignancies. Accordingly, we aimed to clarify the predictive markers for rituximabinduced IRRs in renal transplant recipients. This retrospective study included 116 inpatients aged ≥18 years who received an initial dose of 150 mg/m 2 of rituximab for desensitization before renal transplantation with loxoprofen and diphenhydramine before rituximab infusion between June 2007 and February 2022. Overall, 45 patients were evaluated and 71 patients were excluded in this study. IRRs were observed in 12 (26.7%) patients. The proportion of men in the IRRs group was significantly higher than that in the non-IRRs group (p 0.023). Additionally, body weight, body surface area (BSA), and body mass index (BMI) were significantly higher in the IRRs group than in the non-IRRs group (body weight, p 0.0058; BSA, p 0.0051; BMI, p 0.017). Their cutoff values for predicting rituximab-induced IRRs, based on the receiver-operating characteristic curve, were 74.850 kg, 1.910 m 2 and 24.164 kg/m 2 , respectively. In conclusion, the male sex, high actual body weight, BSA, and BMI may be new predictive markers for rituximab-induced IRRs in renal transplant recipients. Therefore, clinicians should carefully monitor patients who receive rituximab before renal transplantation and present with the predictive markers.

Patients with infusion-related reactions on fixed-dose rituximab treatment have higher body surface area than those without infusion-related reactions in adults with frequently relapsing minimal change nephrotic syndrome: a retrospective study

“…In this study, we revealed that the BSA in the IRR group was significantly higher than that in the non-IRR group in adults with frequently relapsing MCNS, consistent with our previous findings [ 7 ]. There is a positive correlation between BSA and blood volume [ 13 ].…”

“…Therefore, we could not perform a multivariate analysis, adjust the p -value to eliminate the possibility of type one error, and calculate a meaningful cutoff for BSA. However, the main outcome of our study was the examination of the relationship between physique-related factors and rituximab-induced IRRs, and our results were consistent with those of previous studies [ 5 , 7 ]. Consequently, we considered that our results were reliable, and the possibility of type one error was low.…”

“…In our previous study, male sex, high body weight, and high BMI were also found to be predictive markers for rituximab-induced IRRs [ 7 ]. However, the proportion of patients who were male and had a high body weight and BMI in the IRR group tended to be higher than that in the non-IRR group.…”

“…Factors strongly related to tumors, including tumor mass, bone marrow infiltration, high soluble interleukin-2 receptor levels, and low hemoglobin levels, have been reported as predictive markers [ 3 – 6 ]. In our previous study involving renal transplant recipients without malignancy, male sex, high body weight, body surface area (BSA), and body mass index (BMI) were found to be associated with rituximab-induced IRRs [ 7 ]. As rituximab dosage correlates with BSA, these four factors may be associated with rituximab-induced IRRs.…”