The low dose of rituximab in ABO-incompatible kidney transplantation without a splenectomy: a single-center experience

Shirakawa, Hiroki; Ishida, Hideyuki; Shimizu, Tomokazu; Omoto, Kazuya; Iida, Shoichi; Toki, Daisuke; Tanabe, Kazunari

doi:10.1111/j.1399-0012.2010.01384.x

Cited by 77 publications

(57 citation statements)

References 16 publications

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“…According to lymphocyte subset analysis at our institution, the peripheral CD19 population started to recover at 6 months after the administration of a rituximab dose of 375 mg/m 2 and at 2 months with a single dose of 200 mg (data not shown). These findings did not correspond to the report of Shirakawa et al [19], which found that most patients who were followed up for >12 months exhibited no recovery in the peripheral CD19 level at 12 months after administration, regardless of rituximab dose. Based on this result, we modified our protocol to maintain at least 2 weeks between use of rituximab and PP.…”

Section: Discussioncontrasting

confidence: 66%

Short-Term Outcomes of ABO-Incompatible Living Donor Kidney Transplantation With Uniform Protocol: Significance of Baseline Anti-ABO Titer

Lee

Park

et al. 2016

Transplantation Proceedings

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Section: Discussioncontrasting

confidence: 66%

Short-Term Outcomes of ABO-Incompatible Living Donor Kidney Transplantation With Uniform Protocol: Significance of Baseline Anti-ABO Titer

Lee

Park

et al. 2016

Transplantation Proceedings

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“…The dosage of 375 mg/m 2 body surface (lymphoma therapy protocols) has been proven to be safe and efficient [21,22]; hence we employed this dose herein. The effect of lower rituximab doses was also tested on splenic B-cells, and low-dose protocols have been successfully used [23]. To evaluate the clinical merit/demerit of the reduced dose of rituximab treatment, a prospective randomized clinical trial comparing the transplant outcomes and adverse effects of different rituximab doses is necessary.…”

Section: Discussionmentioning

confidence: 99%

Different sensitivity of rituximab-treatment to B-cells between ABO-incompatible kidney and liver transplantation

et al. 2016

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A desensitization protocol with rituximab is currently widely used for kidney transplantation (KT) and liver transplantation (LT) across the ABO blood group-incompatible (ABO-I) barrier. However, it remains to be elucidated whether rituximab is equally effective for B-cell and T-cell immune responses in both KT and LT recipients. To clarify these effects of rituximab, we enrolled 46 KT and 77 LT recipients in this study. The proportion of peripheral blood B-cells was determined at the perioperative period. T-cell responses to allostimulation were evaluated by a mixed lymphocyte reaction (MLR) assay. One week after rituximab administration, peripheral B-cells became undetectable in ABO-I KT recipients but remained detectable in some of the ABO-I LT recipients; B-cells were undetectable in both groups by week 2. B-cells remained below the detection limit throughout the first year in the ABO-I KT recipients, whereas they reappeared in the periphery after 6months in the ABO-I LT recipients. There were no significant differences in alloreactive T-cell responses based on MLR analyses between ABO-I and ABO-compatible groups. This study indicates that rituximab has differing B-cell sensitivity between KT and LT recipients and a minimal effect on the alloreactive T-cell responses in KT and LT recipients.

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“…Splenectomies were performed at the time of transplantation between 1989 and 2004, and thereafter as an alternative to splenectomy, one dose of rituximab was administered 5-7 days before transplantation (12). Figure 2B shows the current immunosuppressive regimen for ABO-ILKT that has been used at our institution since 2005 (13). TAC is initiated 7 days before transplantation at 0.10 mg/kg/day, then the dose is adjusted to maintain a TAC trough level of 6-8 ng/mL in the whole blood for 1 or 2 months postoperatively, and a trough level of 3-5 ng/mL thereafter.…”

Section: Immunosuppressive Regimens and Desensitization Protocolsmentioning

confidence: 99%

ABO-Incompatible Living Kidney Transplants: Evolution of Outcomes and Immunosuppressive Management

Okumi

Toki

Nozaki

et al. 2016

American Journal of Transplantation

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ABO-incompatible living kidney transplantation (ABO-ILKT) has steadily become more widespread. However, the optimal immunosuppressive regimen for ABO-ILKT remains uncertain. We aimed to determine the longitudinal changes in the outcomes from ABO-ILKT compared with those from ABO-compatible living kidney transplantation (ABO-CLKT) over the last 25 years. Of 1195 patients who underwent living kidney transplantations (LKT) at our institute between 1989 and 2013, 1032-including 247 ABO-ILKT and 785 ABO-CLKT cases-were evaluated for graft survival, patient survival, infectious adverse events, and renal function. The patients were divided into four groups according to the transplantation era and ABO-compatibility. In the past decade, ABO-ILKT and ABO-CLKT recipients yielded almost equivalent outcomes with respect to the 9-year graft survival rates, which were 86.9% and 92.0%, respectively (hazard ratio [HR] 1.38, 95% confidence interval [CI] 0.59-3.22, p ¼ 0.455). The graft survival rate for ABO-ILKT conducted between 2005 and 2013 was better than that for ABO-ILKT conducted between 1998 and 2004 (HR 0.30, 95% CI 0.13-0.72, p ¼ 0.007). ABO-ILKT recipients showed substantial improvements in the graft survival rate over time. Graft survival was almost identical over the past decade, regardless of ABO-incompatibility. Currently, ABO-ILKT is an acceptable treatment for patients with end-stage renal disease.

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The low dose of rituximab in ABO-incompatible kidney transplantation without a splenectomy: a single-center experience

Abstract: The patients in Group II showed excellent results similar to Group I. These results suggest that the low dose of rituximab (200 mg/body) is the sufficient dose in ABO-i kidney transplantation.

Cited by 77 publications

References 16 publications

Short-Term Outcomes of ABO-Incompatible Living Donor Kidney Transplantation With Uniform Protocol: Significance of Baseline Anti-ABO Titer

Short-Term Outcomes of ABO-Incompatible Living Donor Kidney Transplantation With Uniform Protocol: Significance of Baseline Anti-ABO Titer

Different sensitivity of rituximab-treatment to B-cells between ABO-incompatible kidney and liver transplantation

ABO-Incompatible Living Kidney Transplants: Evolution of Outcomes and Immunosuppressive Management

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