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

Vega, Jorge; Goecke, Helmuth; Carrasco, Alejandra; Escobar, Carlos; Escobar, Max; Espinosa, Roberto; Méndez, Gonzalo; Rodríguez, María de los Ángeles

doi:10.1007/s10157-010-0387-8

Cited by 6 publications

(6 citation statements)

References 14 publications

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“…Only case series were previously reported, and a systematic review of acute AMR treatment published in October 2012 showed insufficient data to guide treatment. 12,[16][17][18][19][20][21][22][23][24][25][26][27][28][29]32 We showed that 1-year graft survival for AMR treated with IVIg, PE, and CS with or without rituximab was excellent, and we could not demonstrate a supplementary efficacy of rituximab by graft survival or our primary endpoint. An additional beneficial effect of PE and rituximab on graft survival was reported in a group of 12 patients receiving IVIg, PE, and rituximab (92%) as compared with a historical group of 12 patients receiving only IVIg (50%) 29 ; however, the respective impact of PE and rituximab could not be assessed, especially because graft survival was observed in about 80% of patients receiving IVIg and PE treatment in the literature.…”

Section: Discussionmentioning

confidence: 89%

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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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Section: Discussionmentioning

confidence: 89%

“…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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Section: Clinical Use Of Rituximab In Renal Transplantationmentioning

confidence: 99%

“…Almost all the reports of the use of rituximab as a treatment for acute renal allograft rejection (in addition to a variety of other treatments including plasmapheresis, steroids, OKT3, IVIG, alemtuzumab and ATG) have been purely descriptive, either single-case reports [42][43][44][45][46][47] or case series [48][49][50][51][52][53][54][55] (see Table 3). There has been only one randomized controlled trial: Zarkhin et al [56] randomized 20 paediatric patients with biopsy proven acute rejection (BPAR) and a finding of B cell infiltrates in their renal allograft to receive either four doses of rituximab or no additional treatment.…”

Section: Rituximab As a Treatment For Acute Renal Allograft Rejectionmentioning

confidence: 99%

Rituximab in renal transplantation

Barnett¹,

Hadjianastassiou²,

Mamode³

2013

Transpl Int

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SummaryRituximab is a chimeric anti-CD20 monoclonal antibody that leads to B cell depletion. It is not licensed for use in renal transplantation but is in widespread use in ABO blood group incompatible transplantation. It is an effective treatment for post-transplant lymphoproliferative disorder, and is also used in both HLA antibody incompatible renal transplantation and the treatment of acute rejection. Recent evidence suggests rituximab may prevent the development of chronic antibody mediated rejection. The mechanisms underlying its effects are likely to relate both to long-term effects on plasma cell development and to the impact on B cell modulation of T cell responses. Rituximab (in multiple doses or in combination with other monoclonal antibodies and/or other immunosuppressants) may lead to an increase in infectious complications, although the evidence is not clear. Rarely, the drug can cause a cytokine release syndrome, thrombocytopenia and neutropenia. It has been related to an increased risk of progressive multifocal leucoencephalopathy and, recently, deaths from cardiovascular causes. Trials examining the effects of rituximab in induction therapy for compatible renal transplantation and the treatment of chronic antibody mediated rejection are ongoing. These trials should aid greater understanding of the role of B-cells in the alloresponse to renal transplantation.

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“…In fact, it is expressed in various types of immune cells, including Th1 T cells, Th17 effector T cells, activated B cells, and activated dendritic cells. [19][20][21] In this report, we presented a patient who had acute cellular rejection that was resistant to conventional antirejection therapy. Rejection was successfully reversed with specific monoclonal antibodies against CD20.…”

mentioning

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

Cited by 6 publications

References 14 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 renal transplantation

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

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