The effect of rituximab dose on infectious complications in ABO-incompatible kidney transplantation

Abstract

Standard RIT increased the risk of serious infection when compared with reduced-dose RIT. Reduced-dose RIT might be sufficient for ABOi KT without increasing the risk of serious infection.

Pneumocystis pneumonia occurrence and prophylaxis duration in kidney transplant recipients according to perioperative treatment with rituximab: a single-center, retrospective study

“…[12] In our results, rituximab dose did not show significant association with PCP occurrence; this result may be due to the abrupt and long-lasting effects of B-cell depression, and because the incidence of PCP was too small to obtain statistical significance. [12] CD4 + T lymphocytes orchestrate the defense against P. jiroveci, and low CD4+ T lymphocyte count is thus suggested as an independent risk factor associated with PCP in solid organ transplant recipients. [2] In vivo studies have suggested a mechanism for how rituximab may increase the risk of PCP by inducing B-cell depletion: [23,24] Lind et al showed that owing to the absence of P. jiroveci-specific antibody, mice with B-cell deficiency are more vulnerable to PCP, showing that as antigen presenting cells, B-cells play an important role in the defense response against P. jiroveci.…”

“…In our retrospective study using the database of a single large center, we showed that perioperative rituximab treatment had 3.09 times higher hazards of PCP occurrence after adjusting for other risk factors, which is in line with the results of previous studies. [2,5,7,8] Rituximab dose was suggested to be related with serious infectious complications following transplant, [11,12] with Lee et al reporting that recipients treated with standard dose rituximab had higher risk of fungal infection than those who received lower dose of rituximab. [12] In our results, rituximab dose did not show significant association with PCP occurrence; this result may be due to the abrupt and long-lasting effects of B-cell depression, and because the incidence of PCP was too small to obtain statistical significance.…”

“…[2,5,7,8] Rituximab dose was suggested to be related with serious infectious complications following transplant, [11,12] with Lee et al reporting that recipients treated with standard dose rituximab had higher risk of fungal infection than those who received lower dose of rituximab. [12] In our results, rituximab dose did not show significant association with PCP occurrence; this result may be due to the abrupt and long-lasting effects of B-cell depression, and because the incidence of PCP was too small to obtain statistical significance. [12] CD4 + T lymphocytes orchestrate the defense against P. jiroveci, and low CD4+ T lymphocyte count is thus suggested as an independent risk factor associated with PCP in solid organ transplant recipients.…”

“…[9,10] However, recent studies have reported that rituximab increases the risk of opportunistic infections including PCP with fulminant clinical course and mortality. [11][12][13] Since 2009, approximately 20% of KT performed at our center undergo pretransplant desensitization with rituximab in order to overcome the human leukocyte antigen (HLA) or blood group A/B barriers. [11,14] After encountering rituximab-treated KT recipients who later developed PCP at few months after prophylaxis discontinuation, we sought to obtain empirical evidence for the benefit of prolonged prophylaxis duration.…”

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“…The risk of serious infection was reported to be more frequent with standard rituximab (375 mg/m 2 ) than with reduced-dose rituximab (200 mg/m 2 ). 22 In addition, Gulleroglu and associates 23 reported that the combined use of rituximab with additional treatments such as antithymocyte globulin, IVIg, and repeated plasma exchange may be associated with high risk of infections. They recommended closely monitoring these patients, especially those who receive T-cell-depleting agents.…”