Munoz A S, Rioveros A A, Cabanayan-Casasola C B, Danguilan R A, Ona E T
Department of Adult Nephrology, National Kidney and Transplant Institute, Quezon City, Philippines.
Transplant Proc. 2008 Sep;40(7):2218-21. doi: 10.1016/j.transproceed.2008.07.046.
Rituximab, an anti-CD20 monoclonal antibody therapy, depletes B cells and suppresses antibody production. This study sought to describe the efficacy and safety of rituximab among seven highly sensitized kidney transplant patients.
A highly sensitized patient was defined as panel-reactive antibody (PRA) >30%, more than three pregnancies, or history of positive tissue crossmatch. Demographics, immunological risk profile, and immunosuppression were collected on all highly sensitized patients transplanted from March to July 2007 and given rituximab. We noted graft function as well as clinical events posttransplantation.
The seven patients included in the study showed a mean age of 39 years (range = 17-60) and a mean follow-up of 3 months (range = 1.5-5). Their average PRA was 62% with mean HLA mismatches of three. Five patients (71%) were retransplantations; one had a history of a positive crossmatch, and two had multiple pregnancies. Two had donor-specific antibody, but negative tissue crossmatches. All had living donors. Six patients received a single dose of rituximab (375 mg/m2) 1 day prior to transplantation and one received two doses after 19 sessions of plasmapheresis. All were given tacrolimus, mycophenolate, and steroids combined with induction therapy using 30 mg alemtuzumab in 33%; two doses of 20 mg basiliximab in 33%; and seven doses of 1 mg/kg/dose of daclizumab in 14%. Mean shown creatinine levels were 1.1 and 1.2 mg/dL at 1 and 6 months posttransplantation. Two recipients experienced acute humoral rejections within 1 month after transplantation. Both were given steroid pulsing, one of whom was steroid-resistant necessitating alemtuzumab therapy and plasmapheresis. Graft function of both improved with creatinine values of 1.3 mg/dL on discharge. No episodes of infection were noted.
Rituximab can be safely administered and may be effective to improve outcomes among highly sensitized kidney transplant patients.
利妥昔单抗是一种抗CD20单克隆抗体疗法，可消耗B细胞并抑制抗体产生。本研究旨在描述利妥昔单抗在7例高敏肾移植患者中的疗效和安全性。
高敏患者定义为群体反应性抗体（PRA）>30%、怀孕超过3次或组织交叉配型阳性史。收集了2007年3月至7月间接受移植并使用利妥昔单抗的所有高敏患者的人口统计学资料、免疫风险概况和免疫抑制情况。我们记录了移植后的移植物功能以及临床事件。
纳入研究的7例患者平均年龄为39岁（范围=17 - 60岁），平均随访3个月（范围=1.5 - 5个月）。他们的平均PRA为62%，平均HLA错配数为3个。5例患者（71%）为再次移植；1例有交叉配型阳性史，2例有多次怀孕史。2例有供者特异性抗体，但组织交叉配型阴性。所有患者均为活体供者。6例患者在移植前1天接受单剂量利妥昔单抗（375 mg/m²），1例在进行19次血浆置换后接受两剂。所有患者均接受他克莫司、霉酚酸酯和类固醇，并联合诱导治疗，33%的患者使用30 mg阿仑单抗；33%的患者使用两剂20 mg巴利昔单抗；14%的患者使用7剂1 mg/kg/剂的达利珠单抗。移植后1个月和6个月时，平均血清肌酐水平分别为1.1和1.2 mg/dL。2例受者在移植后1个月内发生急性体液排斥反应。两者均接受了类固醇冲击治疗，其中1例对类固醇耐药，需要使用阿仑单抗治疗和血浆置换。两者的移植物功能均有改善，出院时肌酐值为1.3 mg/dL。未观察到感染事件。
利妥昔单抗可以安全给药，可能对改善高敏肾移植患者的预后有效。
