Rituximab therapy for acute humoral rejection after kidney transplantation.
A pilot study was performed on eight consecutive renal transplant (RT) patients presenting with acute humoral rejection (AHR) to assess the efficacy of monoclonal anti B cell antibodies, such as rituximab (375 mg/m weekly) for 3 to 5 consecutive weeks, in addition to plasma exchange (PE) steroids, mycophenolate mofetil, and tacrolimus. AHR was associated with increased serum creatinine, the appearance of donor specific alloantibodies (DSA) and the presence of C4d in a transplant biopsy. After a follow up of 10 months (range 7 23) patient and graft survivals were 100% and 75% respectively. Renal function improved in six cases in which serum creatinine decreased from 297+ 140 to 156+ 53 micromol/L (P=0.015) graft loss occurred in two cases; and four patients had infectious complications. At last follow up, DSA had disappeared or decreased in four cases. Rituximab therapy, in addition to PE, might be of benefit for RT patients presenting with AHR.
Transplantation