Single-Dose Rituximab for Recurrent Glomerulonephritis Post-Renal Transplant

Abstract

Background/Aims: Post-renal transplant recurrent glomerulonephritis (GN) contributes to allograft loss. Rituximab treatment has been used in a multidose strategy with variable efficacy and toxicity. We investigated a novel single-dose approach. Methods: A single center, retrospective, cohort study was conducted between January 1998 and April 2012 among renal allograft recipients with recurrent GN treated with rituximab (cases) or without (controls). The primary outcome was complete response (CR, urine protein/creatinine ratio (UP/C) <0.3). Secondary outcomes included partial response (PR >50% reduction in UP/C), response relapse, treatment-response by GN type, acute rejection incidence, time to graft loss, and infection incidence. Results: The median dose of rituximab was 200 mg per patient. Of 20 rituximab cases and 13 controls, CR was achieved in eight (40%) versus four (31%), respectively (p = 0.72). Three subjects in each group achieved PR (p = 0.66). Response relapse was similar between the two groups (p = 0.47). Significantly more subjects with recurrent membranous nephropathy (MN) achieved CR with rituximab treatment (p = 0.029). Acute rejection was lower in the rituximab group versus controls (n = 0 vs. 4; p = 0.046). The mean time to graft loss was much later in the rituximab group (35 months, (95% CI 33-37)) versus controls (29 months, (95% CI 24-35)) at 36 months (p = 0.04). There was no infection increase in rituximab-treated subjects (p = 0.16). Conclusion: Single-dose rituximab for treatment of recurrent GN was associated with less subsequent rejection and longer time to graft loss without increased infection, but was no more effective than regimens not using rituximab at 36-months except those with recurrent membranous GN.

A Case Report of Adrenocorticotropic Hormone to Treat Recurrent Focal Segmental Glomerular Sclerosis Post-Transplantation and Biomarker Monitoring

“…We administered rituximab 200 mg intravenously, once. This low-dose was chosen because of our experience with efficacy with this dose for other recurrent glomerulonephritidies and others have reported that even 100 mg can successfully treat recurrent FSGS ( 13 – 16 ).…”

Long-term outcomes of patients with end-stage kidney disease due to membranous nephropathy: A cohort study using the Australia and New Zealand Dialysis and Transplant Registry

“…The apparent lack of adverse impact of MN on patient survival despite poorer death-censored kidney allograft survival in our study might be related to improvements in immunosuppressive therapy. The anti-PLA2R antibody in the serum is unlikely to have had an impact as the study period was prior to the introduction of this antibody in clinical practice [22, 36–38]. Patients with MN also had a number of favorable characteristics for survival, including greater frequency of early renal service referral and a higher likelihood of pre-emptive kidney transplantation.…”

Membranous nephropathy

“…The authors advocate laboratory monitoring with CD19 B cell count, whose depletion occurs a few weeks after the administration of rituximab and/or blood levels of anti-PLA2R in MN associated with this antigen 76 . In this review 76 , the authors describe a total of 57 cases of MN recurrence in some references 63,[67][68][69][70][78][79][80] , and there are reports of additional cases in other publications [81][82][83] . There are no other immunosuppressive therapies that have been shown to be more effective.…”