Treatment of acute antibody-mediated rejection using Rituximab

Introduction: One of the optimal therapies for most of the end-stage renal disease (ESRD) patients istransplantation. Acute Antibody Mediated Rejection is one type of acute rejection in which antibodies aredirected against donor specific human leukocyte antigen (HLA). Rituximab is one kind of the drugs usedfor AMR treatment based on elimination of circulating Ab. It is a chimeric monoclonal Ab which isspecific for human B lymphocyte– restricted differentiation antigen (CD20). Concerning the incidence ofAMR in transplantation, existence of resistance to usual AMR therapy and their poor outcomes, wedecided to use Rituximab (RTX) in treatment of AMR and to study its outcomes. Material/Patients: Allpatients who underwent renal transplantation from 2009 to 2014 in Chamran and Labbafinejad centersenrolled. these patients further receiving conventional therapy AMR (tacrolimus + Cellcept +corticosteroids ± PP), were treated with one or two dosage of RTX 500mg and the graft s response andthe patient s response to RTX were studied. Results: After 5-11 months follow-up, patients’ survival was100% and grafts survival was 77%. In 17 patients renal function improved which the average creatinine(Cr) in the first month after treatment was 1.6+/-0.5 (P<0.001) and the average Cr in 6 month was 1.5+/-0.8 (P<0.001).Conclusion: In comparison with outcomes reported before in treatment of AMR, our studyobtained excellent outcomes in patient and graft survival (100% and 77% respectively). Our findingssuggest that the usage of RTX in the treatment of AMR at least in short and medium term may beeffective.

Treatment of acute antibody-mediated rejection using Rituximab Keywords:

Rituximab , Renal Transplantation , Acute Antibody-Mediated Rejection