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Transplantation ; 87(2): 286-9, 2009 Jan 27.
Article in English | MEDLINE | ID: mdl-19155986

ABSTRACT

Rituximab may improve graft survival in renal acute antibody-mediated rejection (AMR), but data confirming efficacy and optimal dosing is lacking. High-dose regimens may be associated with significant rates of infective complications. We therefore conducted a pilot study of a single low-fixed dose (500 mg) of rituximab in seven consecutive patients with AMR resistant to standard therapy. After a mean follow-up of 21 months (range, 9.5-33 months), graft and patient survival were 100% with serum creatinine levels significantly lower than peak rejection levels (171+/-73 micromol/L vs. 559+/-358 micromol/L, P=0.028). B cells were undetectable in all patients for more than or equal to 6 months and in six of seven patients for more than or equal to 12 months after rituximab. Three patients encountered a significant infective complication including cytomegalovirus reactivation, viral pneumonia, and polyoma viral nephropathy. All have since resolved. A single low-fixed dose of rituximab may help improve graft survival in AMR and offers the potential advantage of reduced infective complications.


Subject(s)
Antibodies, Monoclonal/administration & dosage , Antibody Formation/drug effects , Graft Rejection/drug therapy , Graft Survival/drug effects , Kidney Transplantation/immunology , Adult , Aged , Antibodies, Monoclonal, Murine-Derived , B-Lymphocytes/drug effects , B-Lymphocytes/immunology , Creatinine/blood , Female , Graft Rejection/immunology , Graft Survival/immunology , Humans , Immunoglobulins, Intravenous/administration & dosage , Male , Middle Aged , Pilot Projects , Plasma Exchange , Rituximab , Salvage Therapy , Time Factors , Treatment Outcome , Virus Diseases/immunology , Virus Diseases/prevention & control
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