Nakao T, Ushigome H, Kawai K, Nakamura T, Harada S, Koshino K, Suzuki T, Ito T, Nobori S, Yoshimura N
Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Transplant Proc. 2015 Apr;47(3):644-8. doi: 10.1016/j.transproceed.2014.12.033.
The introduction of rituximab has led to a growing tendency to perform ABO-incompatible living-donor kidney transplantation (LDKT) without splenectomy. However, the optimal dosage of rituximab is undefined.
Fifty-five LDKT recipients who had neither a history of hepatitis B infection nor positive crossmatch were enrolled between October 2005 and June 2014. Recipients were divided into three groups by year of transplantation: 2005 to 2008; 2009 to 2011; and 2012 to 2014. Percentages of CD20-positive B lymphocytes and blood-group antibody titers were monitored before renal transplantation. An initial rituximab dosage of 100 mg/body (for titers below 64) or 200 mg/body (for titers above 128) was administered 2 weeks before transplantation. If the percentage of peripheral B lymphocytes remained greater than 0.5%, additional rituximab (100 mg or 200 mg) was administered. Patient demographics, patient survival, graft survival, and complication rates were compared.
Nine patients received rituximab 100 mg/body (low-dose rituximab [LDR] group). Overall survival and graft survival rates did not differ significantly between the LDR group and other cases. The incidences of myelosuppression and viral infection were lower in the LDR group than the other cases.
A low dose of rituximab (100 mg/body) is adequate in ABO-incompatible LDKT, especially in cases with low blood-type antibody titer against ABO-antigens. Rituximab dosage reduction has been successful in our hospital without serious complications. Moreover, as over-dosage of rituximab may cause myelosuppression, it is reasonable to believe that LDR is a suitable option to safely perform ABO-incompatible LDKT without splenectomy.
利妥昔单抗的引入使得在不进行脾切除术的情况下进行ABO血型不相容的活体供肾肾移植（LDKT）的趋势日益增加。然而，利妥昔单抗的最佳剂量尚未确定。
2005年10月至2014年6月期间纳入了55例既无乙肝感染史也无交叉配型阳性的LDKT受者。根据移植年份将受者分为三组：2005年至2008年；2009年至2011年；以及2012年至2014年。在肾移植前监测CD20阳性B淋巴细胞百分比和血型抗体滴度。在移植前2周给予初始剂量为100mg/体（抗体滴度低于64）或200mg/体（抗体滴度高于128）的利妥昔单抗。如果外周B淋巴细胞百分比仍大于0.5%，则给予额外的利妥昔单抗（100mg或200mg）。比较患者人口统计学、患者生存率、移植物生存率和并发症发生率。
9例患者接受了100mg/体的利妥昔单抗（低剂量利妥昔单抗[LDR]组）。LDR组与其他病例的总生存率和移植物生存率无显著差异。LDR组的骨髓抑制和病毒感染发生率低于其他病例。
低剂量的利妥昔单抗（100mg/体）在ABO血型不相容的LDKT中是足够的，特别是在针对ABO抗原的血型抗体滴度较低的情况下。在我们医院，利妥昔单抗剂量的减少是成功的，且无严重并发症。此外，由于利妥昔单抗过量可能导致骨髓抑制，有理由认为低剂量利妥昔单抗是在不进行脾切除术的情况下安全进行ABO血型不相容LDKT的合适选择。
