Long-Term Outcome of ABO-Incompatible Kidney Transplantation in Patients Treated With Low-Dose Rituximab Regimen

Sasaki, Hajime; Hotta, Kiyohiko; Mitsuke, Akihiko; Fukasawa, Yuichiro; Tanabe, Tatsu; Higuchi, Haruka; Takada, Yuki; Harada, Hiroshi

doi:10.1016/j.transproceed.2020.10.023

Cited by 2 publications

(3 citation statements)

References 23 publications

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“…Subsequently, a total of 75 papers were excluded during either full‐text screening or data extraction. Ultimately, 82 citations 2,6–86 including 65,386 participants met inclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 27 studies reported neutropenia incidence 2 , 6,11,14,15,26,30,31,34,36,39,42,44,46–48,51,60,63,64,68,69,75,76,78,81,85 . The absolute neutrophil count (ANC) threshold to define neutropenia varied widely; the majority of the studies ( n = 12) reported neutropenia with a threshold of ANC <1000/μl 2,6,11,15,26,36,44,51,63,75,81,85 followed by a threshold of <500/μl ( n = 8 11,26,34,42,44,60,81,85 ), <1500/μl ( n = 7 26,44,46,60,68,76,81 ), and <2000/μl ( n = 3 64,78,81 ); in 7 studies 14,30,39,42,47,48,69 , a threshold definition was not reported. In 1 study, 31 neutropenia was defined using an International Classification of Diseases, Ninth Revision (ICD‐9) code.…”

Section: Resultsmentioning

confidence: 99%

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Burden of neutropenia and leukopenia among adult kidney transplant recipients: A systematic literature review of observational studies

Raval

Kistler²,

Tang

et al. 2023

Transplant Infectious Dis

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Background Leukopenia and neutropenia (L/N) may affect treatment decisions, potentially resulting in poor clinical and economic outcomes among kidney transplant recipients (KTRs). The burden of L/N is poorly quantified systematically. This systematic literature review aimed to summarize the incidence of, risk factors for, and clinical and economic outcomes associated with L/N post‐KT. Methods We systematically searched MEDLINE, Embase, and the Cochrane Library (from database inception‐June 14, 2021) and conferences (past 3 years) to identify observational studies examining epidemiology, risk factors, or outcomes associated with L/N among adult KTRs. Results Of 2081 records, 82 studies met inclusion criteria. Seventy‐three studies reported the epidemiology of L/N post‐KT. Pooled incidence of neutropenia, defined as absolute neutrophil counts (ANC) <1000/μl, ranged from 13% to 48% within 1‐year post‐transplant; ANC <500/μl ranged from 15% to 20%. Leukopenia, defined as white blood cell counts <3500/μl, was 19% to 83%. Eleven studies reported independent risk factors associated with L/N post‐KT. D+/R− cytomegalovirus status, mycophenolic acid (MPA), and tacrolimus use were the most consistent risk factors across studies. Fourteen studies reported L/N‐associated clinical outcomes. We noted a trend toward a positive association between neutropenia and acute rejection/opportunistic infections. Mixed findings were noted on the association between L/N and graft failure or mortality. Dosage modifications of valganciclovir, MPA, cotrimoxazole, and anti‐thymoglobulin and the need for granulocyte colony‐stimulating factor (G‐CSF) use were common with L/N. Conclusion Findings suggest post‐transplant L/N were common and associated with frequent modifications of immunosuppressive agents, requiring G‐CSF use, and rejection or opportunistic infections. Findings highlight the need for interventions to reduce risk of L/N post‐KT.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Burden of neutropenia and leukopenia among adult kidney transplant recipients: A systematic literature review of observational studies

Raval

Kistler²,

Tang

et al. 2023

Transplant Infectious Dis

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“…in high-risk patients whose grafts were from either ABO blood type incompatible (ABOi) donors, those who were donor specific antibody (DSA) positive, or had the potential to have recurrence of focal segmental glomerular sclerosis (FSGS) ( Fig 2B ). High-risk patients also received a single dose of the anti-CD20 antibody, rituximab (RIT) (50 mg/m 2 ) as reported previously [ 6 ]. In 33 recently enrolled patients, everolimus was administered from the beginning of the study as an mTOR inhibitors.…”

Section: Methodsmentioning

confidence: 99%

Low dose tacrolimus exposure and early steroid withdrawal with strict body weight control can improve post kidney transplant glucose tolerance in Japanese patients

Mitsuke,

Ohbo,

Arima

et al. 2023

PLoS ONE

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The development of diabetes mellitus (DM) after living donor kidney transplantation (KT) is a risk factor for worsening transplant kidney function, cardiac disease, and cerebrovascular disease, which may affect prognosis after KT. At our institution, all patients’ glucose tolerance is evaluated perioperatively by oral glucose tolerance tests (OGTTs) at pre-KT, and 3, 6, and 12 month (mo.) after KT. We analyzed the insulinogenic index (ISI) and homeostasis model assessment beta cell (HOMA-β) based on the immunoreactive insulin (IRI) levels to determine how glucose tolerance changed after KT in 214 patients who had not been diagnosed with DM before KT. In addition, we analyzed the body mass index (BMI) which may also influence glucose tolerance after KT. The concentration of tacrolimus (TAC) in blood was also measured as the area under the curve (AUC) to examine its effects at each sampling point. The preoperative-OGTTs showed that DM was newly diagnosed in 22 of 214 patients (10.3%) who had not been given a diagnosis of DM by the pre-KT fasting blood sugar (FBS) tests. The glucose tolerance was improved in 15 of 22 DM patients at 12 mo. after KT. ISI and IRI deteriorated only at 3 mo. after KT but improved over time. There was a trend of an inverse correlation between HOMA-β and TAC-AUC. We also found inverse correlations between IRI and an increase in BMI from 3 to 12 mo. after KT. Early corticosteroid withdrawal or the steroid minimization protocol with tacrolimus to maintain a low level of diabetogenic tacrolimus and BMI decrease after KT used by our hospital individualizes lifestyle interventions for each patient might contribute to an improvement in post-KT glucose tolerance.

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Long-Term Outcome of ABO-Incompatible Kidney Transplantation in Patients Treated With Low-Dose Rituximab Regimen

Cited by 2 publications

References 23 publications

Burden of neutropenia and leukopenia among adult kidney transplant recipients: A systematic literature review of observational studies

Burden of neutropenia and leukopenia among adult kidney transplant recipients: A systematic literature review of observational studies

Low dose tacrolimus exposure and early steroid withdrawal with strict body weight control can improve post kidney transplant glucose tolerance in Japanese patients

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