Background: We have adopted a rituximab protocol for immunological high-risk recipients of living kidney transplantations, such as ABO-incompatible and HLA-incompatible kidney transplantations. As the number of recipients receiving rituximab is increasing, adverse events such as neutropenia are now frequently encountered. We investigated the adverse events and lymphocyte recovery after a B cell-depleting treatment, rituximab, in living kidney transplantation.
Materials and Methods: Between 2001 and 2012, 715 recipients underwent transplantations at our department; 399 recipients were not treated with. rituximab, while 316 recipients were treated with rituximab. We compared the overall adverse events and lymphocyte recovery, as detected using flow cytometry, between these two groups.
Results: More recipients without rituximab treatment received anti-rejection therapy, such as steroid pulse therapy, after transplantation, compared with the recipients with rituximab treatment, because of a higher incidence of acute rejection (rit- vs. rit+; 18% vs. 10%). Higher incidences of hypertension (42% vs. 20%), hyperlipidemia (25% vs. 10%), and PTDM (11% vs. 7%) were observed in the recipients without rituximab treatment than in the recipients with rituximab treatment. Also, CMV antigenemia occurred more frequently in recipients without rituximab treatment than in recipients with rituximab treatment (24% vs. 14%). Neutropenia as a result of rituximab administration persisted until 4 years after transplantation, at which time no significant difference in the lymphocyte count was observed between the two groups.
Conclusion: Adverse events in kidney transplant recipients were more frequent among recipients without rituximab treatment, and these recipients required additional immunosuppressive medications because of a higher incidence of acute rejection. The higher incidence of adverse events was believed to have been caused by the higher incidence of acute rejection. However, caution is needed when administering rituximab to kidney transplant recipients because of the possible sudden onset and persistence of neutropenia for as long as 4 years after transplantation.
To cite this abstract in AMA style:Nozaki T, Ishida H, Shimizu T, Omoto K, Toki D, Shirakawa H, Tanabe K. Comparative Study of Adverse Events and Lymphocyte Recovery in Living Kidney Transplantation Patients Treated with/without Rituximab, a B Cell-Depleting Treatment [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/comparative-study-of-adverse-events-and-lymphocyte-recovery-in-living-kidney-transplantation-patients-treated-withwithout-rituximab-a-b-cell-depleting-treatment/. Accessed December 6, 2023.
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