Format

Send to

Choose Destination
Kidney Int. 2014 Feb;85(2):425-30. doi: 10.1038/ki.2013.291. Epub 2013 Aug 14.

Neither pre-transplant rituximab nor splenectomy affects de novo HLA antibody production after renal transplantation.

Author information

1
Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
2
Department of Nephrology, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
3
Department of Transplant Surgery, Masuko Memorial Hospital, Nagoya, Japan.
4
Department of Transplant Surgery, Aichi Medical University, Nagakute, Japan.
5
1] Department of Transplant Immunology, Nagoya University School of Medicine, Nagoya, Japan [2] Department of Surgery II, Nagoya University School of Medicine, Nagoya, Japan.

Abstract

The long-term effect of rituximab and splenectomy on de novo HLA antibody production and chronic antibody-mediated rejection after renal transplantation is uncertain. In order to gain insight on this, we studied 92 ABO-incompatible and 228 ABO-identical/compatible consecutive renal transplant patients and determined their de novo HLA antibody production and graft outcome. Patients with pretransplant donor-specific antibodies had been excluded. ABO-incompatible transplants included 30 recipients treated with rituximab, 51 by splenectomy, or 11 with neither, due to low anti-A or -B antibody titer. Graft survival in ABO-identical/compatible patients (97.7% at 5 years) was significantly higher than in ABO-incompatible (87.0% at 5 years), rituximab (96.7% at 3 years), or splenectomy (85.7% at 5 years) patients. Only four patients had clinical chronic antibody-mediated rejection (two each identical/compatible and incompatible). There was no significant difference in prevalence of de novo HLA antibody, including donor-specific and nondonor-specific antibodies among ABO-identical/compatible patients (13.9%), patients receiving rituximab (14.3%) or splenectomy (13.2%), or among those receiving cyclosporine, tacrolimus, mycophenolate mofetil, mizoribine, and everolimus. Renal function remained stable in most recipients with de novo HLA antibody. Thus, neither pretransplant splenectomy nor rituximab treatment has an inhibitory effect on de novo HLA antibody production during medium-term follow-up. Further study on long-term effects is needed.

PMID:
23945498
DOI:
10.1038/ki.2013.291
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center