Single Dose of Rituximab Plus Plasmapheresis in an HIV Patient With Acute Humoral Kidney Transplant Rejection: A Case Report

Moscoso-Solorzano, Grace Tamara; Baltar, José; Seco, Miguel; López‐Larrea, Carlos; Kirsztajn, Gianna Mastroianni; Ortega, Francisco

doi:10.1016/j.transproceed.2007.09.043

Cited by 12 publications

(14 citation statements)

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“…15 All other reports have been single case reports or case series. [16][17][18][19][20][21][22][23][24][25][26][27][28][29] The findings suggest that rituximab may have some beneficial effects in the treatment of acute AMR along with standard treatment of the condition.…”

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confidence: 99%

One-year Results of the Effects of Rituximab on Acute Antibody-Mediated Rejection in Renal Transplantation

et al. 2016

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One-year Results of the Effects of Rituximab on Acute Antibody-Mediated Rejection in Renal Transplantation

et al. 2016

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“…In the last setting, most reports have referred to the results of RTX use in AMR [1,[3][4][5]10]. Histology is not a specific diagnostic tool for AMR, but severe vasculitis, interstitial hemorrhage, glomerulitis with neutrophils and/or monocytes in glomerular or peritubular capillaries, fibrinoid necrosis, fibrin thrombi and interstitial edema associated with a high percentage of plasma cells, are probably more sensitive indicators of AMR [11,12].…”

Section: Discussionmentioning

confidence: 99%

“…Simultaneous occurrence of AMR and cell-mediated rejection may be a common event, and prominent histologic findings of cell-mediated rejection may mask those of AMR. Because of that, C4d staining and presence of DSA is recommended in addition to histology, to support a diagnosis of AMR [1,3].…”

Section: Discussionmentioning

confidence: 99%

“…AMR therapy is usually based in changing the immunosuppressive drug regimen, plasmapheresis, immunoadsorption and high-dose intravenous human immunoglobulin [1,2]. Recently, anti-B-lymphocyte antibodies (anti-CD20) have been used as rescue therapy for refractory AR, with successful outcomes [1,[3][4][5][6][7][8] We report here the case of a patient with acute TCMR with severe vascular damage and clusters of B-cell lymphocytes in the graft infiltrate, which did not respond to steroid pulses and switching her immunosuppressive drug regimen, being successfully treated with plasmapheresis and anti-CD20 antibodies.…”

Section: Introductionmentioning

confidence: 99%

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Rituximab in the treatment of acute cellular rejection of renal allograft with CD20-positive clusters in the infiltrate

et al. 2010

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A 31-year-old woman with nephronophthisis received a cadaveric kidney transplant, and was immunosuppressed with cyclosporine, azathioprine and steroids. Twelve days after transplant a biopsy showed acute rejection with vascular damage. She was treated with 3 pulses of methylprednisolone and change of immunosuppression to mycophenolate mofetil and tacrolimus, without improving graft function. At day 21, a second biopsy showed accentuation of interstitial and vascular rejection. Antibody-mediated rejection was suspected and plasmapheresis and rituximab were prescribed. Graft function improved rapidly. Staining for C4d was negative and there were no circulating antibodies against the donor. In the interstitial infiltrate there were clusters of B lymphocytes that accounted for 40% of cells, which was thought to be an ominous sign, as it has been associated with poor graft outcome. Acute T-cell-mediated rejection grade III (Banff 07) was diagnosed. Thirty-nine months after transplant her kidney function is stable with no other complication. This clinical case generates the hypothesis that rituximab may have a beneficial role in the therapy of acute cellular rejection when there are clusters of B lymphocytes in the infiltrate and a good response has not been obtained to conventional anti-rejection therapy.

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“…[7][8][9] Anti-CD20 antibodies (rituximab) have been used as rescue therapy for CD20-mediated refractory acute rejection with successful outcomes. 7,[10][11][12][13][14][15] Herein, we report a case of refractory acute cellular rejection with clusters of CD20-positive lymphocyte graft infiltrates, resistant to steroid pulses, plasmapheresis, and switching of immunosuppressive drug regimen, which was successfully treated with anti-CD20 antibodies.…”

Section: Introductionmentioning

confidence: 99%

Refractory CD20 Positive Cellular Rejection in Living Kidney Transplant: A Case Report and Review of Literature

Akl

Sheashaa²,

Rahim³

et al. 2019

Exp Clin Transplant

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Transplant is the optimal therapy for patients with end-stage renal disease. Acute cellular rejection refractory to treatment remains a major risk factor for graft loss and poor outcomes. In this study, we describe a 39-year-old man who received a living-related kidney transplant. Two days after transplant, the patient displayed acute deterioration of graft function. Conventional anti-rejection therapy was initiated, but graft function did not improve. Biopsy revealed acute cellular rejection (grade IIA), and C4d and HLA antibodies were negative. Immuno histochemistry phenotyping revealed clusters of CD20-positive lymphocytes, with 80% being CD3 positive. Rituximab was prescribed, and graft function improved dramatically. After 1 week, a second graft biopsy was done due to lagging of graft function, shown by serum creatinine of 2.1 mg/dL. Biopsy revealed regenerating acute tubular necrosis with disappearance of the CD20-positive lymphocyte cluster infiltrates. Two year, after transplant, the patient's graft function maintained stable. Phenotyping of the cellular infiltrate is important as it may lead to a proper selection of immunosuppression and consequent improvement of graft outcome. Key words: Acute humoral rejection, B-cell-mediated rejection, CD20-mediated rejection, Renal transplantation, Rituximab IntroductionTransplant remains the optimal treatment for patients with end-stage renal disease. 1 Acute graft rejection remains a common complication and affects long-term graft survival. 2,3 Advances in immunosuppressive protocols have led to improvements in acute graft rejection episodes. 3-6 However, acute graft rejection, especially antibody-mediated rejection (AMR), can cause graft loss in some patients and can shorten graft function time in others. The presence of CD20-positive cells in the graft has been associated with poor reversibility of graft function and a trend toward poor graft survival even without AMR. 7-9 Anti-CD20 antibodies (rituximab) have been used as rescue therapy for CD20-mediated refractory acute rejection with successful outcomes. 7,10-15 Herein, we report a case of refractory acute cellular rejection with clusters of CD20-positive lymphocyte graft infiltrates, resistant to steroid pulses, plasmapheresis, and switching of immunosuppressive drug regimen, which was successfully treated with anti-CD20 antibodies. Case ReportA 39-year-old-male with type 2 insulin-dependent diabetes presented with end-stage kidney disease and with both kidneys having small size. The patient had been on regular hemodialysis for 3 years.The patient received a right iliac renal allograft from his 27-year-old brother. The sibling donor had a different compatible blood group, one mismatched HLA DR, negative repeated complement-dependent crossmatch test, and 7% donor nonspecific panel reactive antibody (PRA) class I and 0% PRA class II. There were no complications during the transplant procedure and postoperative period, with total ischemia time of 55 minutes and immediate diuresis. Induction immunosuppr...

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Single Dose of Rituximab Plus Plasmapheresis in an HIV Patient With Acute Humoral Kidney Transplant Rejection: A Case Report

Cited by 12 publications

References 11 publications

One-year Results of the Effects of Rituximab on Acute Antibody-Mediated Rejection in Renal Transplantation

One-year Results of the Effects of Rituximab on Acute Antibody-Mediated Rejection in Renal Transplantation

Rituximab in the treatment of acute cellular rejection of renal allograft with CD20-positive clusters in the infiltrate

Refractory CD20 Positive Cellular Rejection in Living Kidney Transplant: A Case Report and Review of Literature

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