The 5-Year Outcome of ABO-Incompatible Kidney Transplantation With Rituximab Induction

Fuchinoue, Shohei; Ishíi, Yasuo; Sawada, Tokihiko; Murakami, Toru; Iwadoh, Kazuhiro; Sannomiya, Akihito; Koyama, Ichiro; Kubota, Keiichi; Tojimbara, Tamotsu; Nakajima, Ichiro; Teraoka, Satoshi

doi:10.1097/tp.0b013e31820f08e8

Cited by 119 publications

(60 citation statements)

References 15 publications

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“…Oettl et al (11) detected BK viremia in 7 of their 10 ABO-incompatible recipients in a prospective analysis, but no BKVAN was seen on serial protocol biopsy. Large series of ABO-incompatible patients have not reported on the incidence of BK viremia or nephropathy, including the Japanese, who have the most experience with ABO-incompatible (19,20). However, lack of reporting does not imply lack of association.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Outcomes of BK Virus Allograft Nephropathy among ABO- and HLA-Incompatible Kidney Transplant Recipients

Sharif

Alachkar²,

Bagnasco³

et al. 2012

Clinical Journal of the American Society of Nephrology

106

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SummaryBackground and objectives ABO-incompatible kidney transplant recipients may have a higher incidence of BK virus allograft nephropathy (BKVAN) compared with ABO-compatible recipients. It is unclear whether HLAincompatible recipients share this risk or whether this phenomenon is unique to ABO-incompatible recipients.Design, setting, participation, & measurements This study analyzed adult incompatible kidney transplant recipients from 1998 to 2010 (62 ABO-incompatible and 221 HLA-incompatible) and identified patients in whom BKVAN was diagnosed by biopsy (per protocol or for cause). This was a retrospective analysis of a prospectively maintained database that compared BKVAN incidence and outcomes between ABO-and HLA-incompatible recipients, respectively. BKVAN link to rejection and graft accommodation phenotype were also explored. The Johns Hopkins Institutional Review Board approved this study.Results Risk for BKVAN was greater among ABO-incompatible than HLA-incompatible patients (17.7% versus 5.9%; P=0.008). Of BKVAN cases, 42% were subclinical, diagnosed by protocol biopsy. ABO-incompatibility and age were independent predictors for BKVAN on logistic regression. C4d deposition without histologic features of glomerulitis and capillaritis (graft accommodation-like phenotype) on 1-year biopsies of ABO-incompatible patients with and without BKVAN was 40% and 75.8%, respectively (P=0.04). Death-censored graft survival (91%) and serum creatinine level among surviving kidneys (1.8 mg/dl) were identical in ABO-and HLAincompatible patients with BKVAN (median, 1399 and 1017 days after transplantation, respectively).Conclusions ABO-incompatible kidney recipients are at greater risk for BKVAN than HLA-incompatible kidney recipients. ABO-incompatible recipients not showing the typical graft accommodation-like phenotype may be at heightened risk for BKVAN, but this observation requires replication among other groups.

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Section: Discussionmentioning

confidence: 99%

Incidence and Outcomes of BK Virus Allograft Nephropathy among ABO- and HLA-Incompatible Kidney Transplant Recipients

Sharif

Alachkar²,

Bagnasco³

et al. 2012

Clinical Journal of the American Society of Nephrology

106

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“…However, RTX can also ameliorate chronic inflammatory diseases mediated by T and B cells, such as rheumatoid arthritis (8) and multiple sclerosis (9), suggesting that the therapeutic effect of RTX not solely depends on inhibition of antibody production. In renal transplantation, RTX is used successfully in ABOincompatible (ABOi) transplantation (10), in desensitization protocols (11), and for treatment of antibody-mediated rejection (12).…”

Section: Introductionmentioning

confidence: 99%

A Single Dose of Rituximab Does Not Deplete B Cells in Secondary Lymphoid Organs but Alters Phenotype and Function

Kamburova

Koenen

Borgman

et al. 2013

American Journal of Transplantation

167

107

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A single dose of the anti-CD20 monoclonal antibody rituximab induces a nearly complete B cell depletion in peripheral blood, but not in secondary lymphoid organs. Modulation of this remaining B cell population due to rituximab treatment may contribute to the therapeutic effects of rituximab. To assess the in vivo effects of rituximab we used lymph nodes (LNs) collected during renal transplant surgery in patients who had received rituximab 4 weeks earlier in preparation for an ABO-incompatible transplantation. Rituximab treatment resulted in a lower percentage of na € lve (IgD þ CD27 À ) and a higher percentage of switched memory (IgD À CD27 þ ) B cells. Remarkably, transitional (CD24 þþ CD38 þþ ) B cells were virtually lacking in the LNs of rituximab-treated patients. Moreover, LN-derived B cells from rituximab-treated patients produced different amounts of various Ig-subclasses after anti-CD40/IL-21 stimulation ex vivo. Finally, after stimulation of allogeneic T cells with LN-derived B cells from rituximab-treated patients, the proliferated T cells showed a decreased production of IL-17. In conclusion, after treatment with rituximab there remains a B cell population with different functional capacities. Consequently, the effect of rituximab on the immune response will not only be determined by the extent of B cell depletion, but also by the functional properties of the remaining B cells.

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“…A recent study examining the role of rituximab as an induction agent found no benefit compared to placebo [70]. However, it does play a role as a desensitizing agent in patients with preformed donor specific antibodies (DSA), in conjunction with total plasmapheresis and/or intravenous immunoglobulin (IVIG) [71,72].…”

Section: Applicationsmentioning

confidence: 99%

Modern Immunosuppression Regimens in Kidney Transplantation

Afaneh¹,

Aull²,

Kapur³

2012

Current Concepts in Kidney Transplantation

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The 5-Year Outcome of ABO-Incompatible Kidney Transplantation With Rituximab Induction

Abstract: In the long term, inclusion of rituximab in the preoperative regimen yielded an even better outcome than that of ABO-CKT and rituximab-untreated ABO-IKT, without any increase in the risk of infection.

Cited by 119 publications

References 15 publications

Incidence and Outcomes of BK Virus Allograft Nephropathy among ABO- and HLA-Incompatible Kidney Transplant Recipients

Incidence and Outcomes of BK Virus Allograft Nephropathy among ABO- and HLA-Incompatible Kidney Transplant Recipients

A Single Dose of Rituximab Does Not Deplete B Cells in Secondary Lymphoid Organs but Alters Phenotype and Function

Modern Immunosuppression Regimens in Kidney Transplantation

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