Association between CD19-Positive Rate and Antibody-Mediated Rejection Following Rituximab Administration in Kidney Transplant Recipients
Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
Meeting: 2019 American Transplant Congress
Abstract number: D101
Keywords: B cells, Graft function, HLA antibodies, Immunosuppression
Session Information
Session Name: Poster Session D: Kidney Acute Antibody Mediated Rejection
Session Type: Poster Session
Date: Tuesday, June 4, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Rituximab, which suppresses antibody production, is widely used for desensitization in ABO-incompatible and donor-specific antibody-positive kidney transplantation. However, data regarding the effects of individual differences in rituximab-induced B cell suppression on antibody-mediated rejection (AMR) and allograft function remain limited. Therefore, we aimed to evaluate association CD19-positive rate and AMR after kidney transplantation.
*Methods: Overall, 42 patients who received rituximab therapy for pretransplant desensitization in ABO-incompatible (n = 33) and donor-specific antibody-positive (n = 15) kidney transplantation were retrospectively observed. To predict AMR incidence, the peripheral blood CD19-positive rate was determined using the ROC curve and classified into short-acting and long-acting groups. AMR incidence, serum creatinine level, neutropenia incidence, cytomegalovirus antigenemia-positive rate, and rituximab dose were compared between the two groups.
*Results: Eight patients (19%) developed AMR within 38 months after transplantation. The CD19-positive rate at 6, 12, and 18 months after transplantation was found to be a risk factor of AMR. The CD19-positive rate cut-off value for predicting AMR was 4.4%, 6.4%, and 7.7% at 6, 12, and 18 months after transplantation, respectively. On comparing the short-acting and long-acting groups stratified according to the CD19-positive rate cut-off value, AMR incidence was significantly higher in the short-acting group than in the long-acting group at 6 months (71.4% vs. 8.6%, P = 0.0012), 12 months (70.0% vs. 3.1%, P < 0.001), and 18 months (58.3% vs. 3.3%, P < 0.001) after transplantation. The CD19-positive rate of all patients with AMR exceeded the cut-off value at either time of 6, 12, or 18 months. Conversely, the serum creatinine level, neutropenia incidence, cytomegalovirus antigenemia-positive rate, and rituximab dose showed no significant differences between the two groups at each time point.
*Conclusions: The risk of AMR following kidney transplantation is higher in patients with short-term B cell suppression following rituximab administration. Additional rituximab administration may prevent AMR in patients with a CD19-positive rate greater than the cut-off value.
To cite this abstract in AMA style:
Nanmoku K, Shinzato T, Kubo T, Shimizu T, Yagisawa T. Association between CD19-Positive Rate and Antibody-Mediated Rejection Following Rituximab Administration in Kidney Transplant Recipients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/association-between-cd19-positive-rate-and-antibody-mediated-rejection-following-rituximab-administration-in-kidney-transplant-recipients/. Accessed September 7, 2024.« Back to 2019 American Transplant Congress