Division of Renal and Electrolytes and Division of Transplant Surgery, Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
Transplantation. 2018 Jan;102(1):44-58. doi: 10.1097/TP.0000000000001849.
Rituximab is a chimeric anti-CD20 monoclonal protein used in various clinical scenarios in kidney transplant recipients. However, its evidence-based use there remains limited due to lack of controlled studies, limited sample size, short follow-up and poorly defined endpoints. Rituximab is indicated for CD20+ posttransplant lymphoproliferative disorder. It may be beneficial for treating recurrent membranous nephropathy and recurrent allograft antineutrophilic cytoplasmic antibody vasculitis and possibly for recurrent focal segmental glomerulosclerosis. Rituximab, in combination with IVIg/plasmapheresis, appears to decrease antibody level and increase the odds of transplantation in sensitized recipients. The role of Rituximab in ABOi transplant remains unclear, as similar outcomes are achieved without its use. Rituximab is not efficacious in antibody-mediated rejection/chronic antibody-mediated rejection. Strict randomized control trials are necessary to elucidate its true role in these settings.
利妥昔单抗是一种嵌合抗 CD20 单克隆蛋白，用于肾移植受者的各种临床情况。然而，由于缺乏对照研究、样本量有限、随访时间短和终点定义不明确，其在该领域的循证应用仍然有限。利妥昔单抗适用于 CD20+移植后淋巴增殖性疾病。它可能有益于治疗复发性膜性肾病和复发性同种异体抗中性粒细胞胞质抗体血管炎，并可能有益于复发性局灶节段性肾小球硬化症。利妥昔单抗联合 IVIg/血浆置换似乎可以降低抗体水平并增加致敏受者移植的几率。利妥昔单抗在 ABOi 移植中的作用仍不清楚，因为不使用它也可以达到类似的结果。利妥昔单抗在抗体介导的排斥反应/慢性抗体介导的排斥反应中无效。需要严格的随机对照试验来阐明其在这些情况下的真正作用。
