Impact of low-dose rituximab on splenic B cells in ABO-incompatible renal transplant recipients

Toki, Daisuke; Ishida, Hideyuki; Horita, Shigeru; Setoguchi, Kiyoshi; Yamaguchi, Yutaka; Tanabe, Kazunari

doi:10.1111/j.1432-2277.2008.00821.x

Cited by 80 publications

(59 citation statements)

References 23 publications

(68 reference statements)

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“…Raut et al (23) found no statistically significant difference in the titers of anti-ABO IgM and IgG antibodies between an SPL group and a non-SPL group. Toki et al (24) studied the impact of low-dose RIT on the splenic B cell population in recipients of ABOi kidney transplantation and reported the near-complete depletion of CD20þ from the spleen. Consequently, we have recently abandoned SPL.…”

Section: Discussionmentioning

confidence: 99%

ABO-Incompatible Adult Living Donor Liver Transplantation Under the Desensitization Protocol With Rituximab

Song

Lee

Hwang

et al. 2016

American Journal of Transplantation

113

124

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ABO incompatibility is no longer considered a contraindication for adult living donor liver transplantation (ALDLT) due to various strategies to overcome the ABO blood group barrier. We report the largest singlecenter experience of ABO-incompatible (ABOi) ALDLT in 235 adult patients. The desensitization protocol included a single dose of rituximab and total plasma exchange. In addition, local graft infusion therapy, cyclophosphamide, or splenectomy was used for a certain time period, but these treatments were eventually discontinued due to adverse events. There were three cases (1.3%) of in-hospital mortality. The cumulative 3-year graft and patient survival rates were 89.2% and 92.3%, respectively, and were comparable to those of the ABO-compatible group (n ¼ 1301). Despite promising survival outcomes, 17 patients (7.2%) experienced antibody-mediated rejection that manifested as diffuse intrahepatic biliary stricture; six cases required retransplantation, and three patients died. ABOi ALDLT is a feasible method for expanding a living liver donor pool, but the efficacy of the desensitization protocol in targeting B cell immunity should be optimized.

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Section: Discussionmentioning

confidence: 99%

ABO-Incompatible Adult Living Donor Liver Transplantation Under the Desensitization Protocol With Rituximab

Song

Lee

Hwang

et al. 2016

American Journal of Transplantation

113

124

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“…Based on our previous studies, 18 we believe that administration of rituximab at low doses may prevent rejection. Toki and associates 21 reported that administration of a single low dose of RTX, less than the 375 mg/m 2 used in this and previous studies (15,35,150, or 300 mg/m 2 ), had a potent effect, depleting B cells in both the spleen and peripheral blood. 21 We initially administered rituximab at a dose of 375 mg/m 2 .…”

Section: Discussionmentioning

confidence: 99%

“…Toki and associates 21 reported that administration of a single low dose of RTX, less than the 375 mg/m 2 used in this and previous studies (15,35,150, or 300 mg/m 2 ), had a potent effect, depleting B cells in both the spleen and peripheral blood. 21 We initially administered rituximab at a dose of 375 mg/m 2 . However, we have gradually reduced administration to a single dose of 200 mg as a component of the desensitization protocol, with good outcomes.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2015

Exp Clin Transplant

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Objectives: Cytomegalovirus infection is an important cause of morbidity and mortality among recipients undergoing hematopoietic stem cell and solid-organ transplant. The risk of cytomegalovirus infection is high in cytomegalovirus-seronegative recipients of cytomegalovirus-seropositive organs (donor positive/recipient negative) and recipients with strong immunosuppressive status such as those receiving rituximab induction or antirejection treatment. However, it remains unclear how rituximab affects patients with primary cytomegalovirus infection. We evaluated the effects of low-dose rituximab therapy on clinical and immunologic outcomes in recipients who were donor positive but recipient negative for primary cytomegalovirus infections. Materials and Methods: We conducted a retrospective review of patients with primary cytomegalovirus infections from January 2005 to March 2014. Patient outcomes were compared between groups administered given rituximab or given no intervention at the time of transplant. Results: Our study group included 49 recipients with primary cytomegalovirus infection, including 32 who received rituximab therapy (group 1) and 17 who did not (group 2). No significant differences were observed between groups in the duration of cytomegalovirus seroconversion (P = .0570) and initial cytomegalovirus immunoglobulin G titers (P = .8418). Conclusions: Rituximab induction therapy does not affect clinical or immunologic outcomes of primary cytomegalovirus infection, even in high-risk recipients who are donor positive but recipient negative for primary cytomegalovirus infections.

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“…CD20 is expressed on naive and mature activated B cells as well as some memory B cells. B cell depletion occurs via antibody dependent cytotoxicity and can be rapid, over 3-4 days and sustained, lasing for almost up to a year [9].…”

Section: Anti-cd20 Antibody As Surrogate For Splenectomymentioning

confidence: 99%

“…The optimal dose of rituximab remains unknown. Toki [9] et al studied the effect of B cell depletion with increasing doses of rituximab (10,15,35,150, 300 mg/m 2 ) in 5 patients. All but one dosage of rituximab (10 mg/m 2 ) was able to completely eliminate B cells from circulation in 30 days.…”

Section: Anti-cd20 Antibody As Surrogate For Splenectomymentioning

confidence: 99%