Rituximab Therapy for Acute Humoral Rejection After Kidney Transplantation

Authors:
  • CGCéline Guilbeaud-Frugier
    Céline Guilbeaud-Frugier
  • MFMarylise Fort
    Marylise Fort
  • AMAnne Modesto
    Anne Modesto
  • AMArnaud Mari
    Arnaud Mari
  • DRDavid Ribes
    David Ribes
  • OCOlivier Cointault
    Olivier Cointault
  • LLLaurence Lavayssière
    Laurence Lavayssière
  • JGJoelle Guitard
    Joelle Guitard
  • DDDominique Durand
    Dominique Durand
  • LRLionel Rostaing
    Lionel Rostaing
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Abstract
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/m2 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 μmol/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.

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