Incidence and Predictive Factors for Infectious Disease after Rituximab Therapy in Kidney‐Transplant Patients

Abstract

(1.25-142.7) months for control patients, the incidence of infectious disease was 45.45% and 53.9% (ns), respectively. The incidence of bacterial infection was similar between the two groups, whereas the viralinfection rate was significantly lower, and the rate of fungal infection was significantly higher in the rituximab group. Nine out of 77 patients (11.68%) died after rituximab therapy, of which seven deaths (9.09%) were related to an infectious disease, compared to 1.55% in the controls (p = 0.0007). In the whole population, the independent predictive factors for infectioninduced death were the combined use of rituximab and antithymocyte-globulin given for induction or antirejection therapy, recipient age, and bacterial and fungal infections. After kidney transplantation, the use of rituximab is associated with a high risk of infectious disease and death related to infectious disease.

Effects of Rituximab on the Development of Viral and Fungal Infections in Renal Transplant Recipients

“…Previously, Kamar et al noted that BK virus was the most common virus detected in RTX-treated patients [8], and Habicht et al found a nonsignificantly higher rate of BK in ABO-incompatible recipients administered RTX [11]. The rates of BK viremia and nephropathy in our cohort are congruent with rates previously reported in the renal transplant population [18][19][20][21].…”

“…A significantly higher incidence of fungal infections was noted in the RTX group, a similar finding albeit at a lower rate than Kamar's report (17%) [8]. In contrast to their results, however, the severity of fungal infections tended to be less in our RTX patients.…”

“…The safety profile of RTX in this population remains unclear, however, with conflicting data on its association with infectious complications [3,[7][8][9][10][11][12][13][14]. This study of 55 kidney transplant patients treated with RTX for its common peri-and posttransplant indications favors an association an increased risk of infections with RTX.…”

“…T-lymphocyte depleting preparations in particular have been associated with an increased risk, as opposed to nonlymphocyte depleting agents which demonstrated similar infectious risks when compared to placebo [5,6]. RTX has generally been considered to have an acceptable safety profile in hematological and autoimmune disorders; however, whether it can be used without an increased risk of infectious complications remains controversial in the immunosuppressed population [3,[7][8][9][10][11][12][13][14].…”

Antibody immunosuppressive therapy in solid organ transplant

“…Although the rate of infection was similarly high in both groups (45.5% rituximab-treated vs. 53.9% controls), the mortality rate was significantly higher in the rituximab group (9.1% vs. 1.6%). 27 Other reports have documented cases of late-onset Pneumocystis jiroveci pneumonia, 28 cryptogenic organizing pneumonia 29 and JC virus associated PML 30 in patients treated with rituximab in post-transplant period. These potential complications show that the particular indications for rituximab usage must be further elucidated through larger-scale randomized trials that compare rituximab with conventional therapies.…”