The effect of rituximab dose on infectious complications in ABO-incompatible kidney transplantation

Juhan Lee, Jae Geun Lee, Sinyoung Kim, Seung Hwan Song, Beom Seok Kim, Hyun Ok Kim, Myoung Soo Kim, Soon Il Kim, YuSeun Kim, Kyu Ha Huh

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background Rituximab (RIT) improves the outcomes of ABO-incompatible (ABOi) kidney transplantation (KT), but it has been associated with infectious complications. The aim of this study was to investigate infectious complications according to the dose of RIT in ABOi KT. MethodsWe analyzed 213 recipients [118 ABO-compatible (ABOc) KT and 95 ABOi KT] who underwent living donor KT between 2010 and 2014. ABOi KT patients were categorized by RIT dose: standard RIT (375 mg/m 2 , n = 76) versus reduced RIT (200 mg, n = 19). All patients received basiliximab and maintained on triple immunosuppression consisting of tacrolimus, prednisone and mycophenolate mofetil. Infectious complications and post-transplant outcomes were analyzed for 1 year following KT. ResultsThe rates of overall infectious complications among the three groups were comparable (22.9% in ABOc KT, 38.2% in standard RIT and 26.3% in reduced RIT, P = 0.069). In the standard RIT group, hepatitis B virus reactivation occurred in three recipients (3.9%) with hepatitis B surface antigen[-]/anti-hepatitis B core antibody[+]. Three cases (3.9%) of Pneumocystis jirovecii pneumonia occurred in the standard RIT group. Serious infections developed in 13 of the ABOc KT (11.0%), 20 from the standard RIT group (26.3%) and 2 from the reduced RIT group (10.5%, P = 0.015). Standard-dose RIT was found to be an independent risk factor for serious infections [hazard ratio: 2.59 (95% confidence interval: 1.33-5.07), P = 0.005]. There were no significant differences in rejection, renal function, graft survival and patient survival between standard and reduced RIT groups. ConclusionsStandard RIT increased the risk of serious infection when compared with reduced-dose RIT. Reduced-dose RIT might be sufficient for ABOi KT without increasing the risk of serious infection.

Original languageEnglish
Pages (from-to)1013-1021
Number of pages9
JournalNephrology Dialysis Transplantation
Volume31
Issue number6
DOIs
Publication statusPublished - 2016 Jun 24

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Kidney Transplantation
Rituximab
Infection
Mycophenolic Acid
Hepatitis B Antibodies
Pneumocystis carinii
Pneumocystis Pneumonia
Living Donors
Tacrolimus
Graft Survival
Hepatitis B Surface Antigens
Prednisone
Hepatitis B virus
Immunosuppression

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Transplantation

Cite this

Lee, J., Lee, J. G., Kim, S., Song, S. H., Kim, B. S., Kim, H. O., ... Huh, K. H. (2016). The effect of rituximab dose on infectious complications in ABO-incompatible kidney transplantation. Nephrology Dialysis Transplantation, 31(6), 1013-1021. https://doi.org/10.1093/ndt/gfw017
Lee, Juhan ; Lee, Jae Geun ; Kim, Sinyoung ; Song, Seung Hwan ; Kim, Beom Seok ; Kim, Hyun Ok ; Kim, Myoung Soo ; Kim, Soon Il ; Kim, YuSeun ; Huh, Kyu Ha. / The effect of rituximab dose on infectious complications in ABO-incompatible kidney transplantation. In: Nephrology Dialysis Transplantation. 2016 ; Vol. 31, No. 6. pp. 1013-1021.
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abstract = "Background Rituximab (RIT) improves the outcomes of ABO-incompatible (ABOi) kidney transplantation (KT), but it has been associated with infectious complications. The aim of this study was to investigate infectious complications according to the dose of RIT in ABOi KT. MethodsWe analyzed 213 recipients [118 ABO-compatible (ABOc) KT and 95 ABOi KT] who underwent living donor KT between 2010 and 2014. ABOi KT patients were categorized by RIT dose: standard RIT (375 mg/m 2 , n = 76) versus reduced RIT (200 mg, n = 19). All patients received basiliximab and maintained on triple immunosuppression consisting of tacrolimus, prednisone and mycophenolate mofetil. Infectious complications and post-transplant outcomes were analyzed for 1 year following KT. ResultsThe rates of overall infectious complications among the three groups were comparable (22.9{\%} in ABOc KT, 38.2{\%} in standard RIT and 26.3{\%} in reduced RIT, P = 0.069). In the standard RIT group, hepatitis B virus reactivation occurred in three recipients (3.9{\%}) with hepatitis B surface antigen[-]/anti-hepatitis B core antibody[+]. Three cases (3.9{\%}) of Pneumocystis jirovecii pneumonia occurred in the standard RIT group. Serious infections developed in 13 of the ABOc KT (11.0{\%}), 20 from the standard RIT group (26.3{\%}) and 2 from the reduced RIT group (10.5{\%}, P = 0.015). Standard-dose RIT was found to be an independent risk factor for serious infections [hazard ratio: 2.59 (95{\%} confidence interval: 1.33-5.07), P = 0.005]. There were no significant differences in rejection, renal function, graft survival and patient survival between standard and reduced RIT groups. ConclusionsStandard RIT increased the risk of serious infection when compared with reduced-dose RIT. Reduced-dose RIT might be sufficient for ABOi KT without increasing the risk of serious infection.",
author = "Juhan Lee and Lee, {Jae Geun} and Sinyoung Kim and Song, {Seung Hwan} and Kim, {Beom Seok} and Kim, {Hyun Ok} and Kim, {Myoung Soo} and Kim, {Soon Il} and YuSeun Kim and Huh, {Kyu Ha}",
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Lee, J, Lee, JG, Kim, S, Song, SH, Kim, BS, Kim, HO, Kim, MS, Kim, SI, Kim, Y & Huh, KH 2016, 'The effect of rituximab dose on infectious complications in ABO-incompatible kidney transplantation', Nephrology Dialysis Transplantation, vol. 31, no. 6, pp. 1013-1021. https://doi.org/10.1093/ndt/gfw017

The effect of rituximab dose on infectious complications in ABO-incompatible kidney transplantation. / Lee, Juhan; Lee, Jae Geun; Kim, Sinyoung; Song, Seung Hwan; Kim, Beom Seok; Kim, Hyun Ok; Kim, Myoung Soo; Kim, Soon Il; Kim, YuSeun; Huh, Kyu Ha.

In: Nephrology Dialysis Transplantation, Vol. 31, No. 6, 24.06.2016, p. 1013-1021.

Research output: Contribution to journalArticle

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T1 - The effect of rituximab dose on infectious complications in ABO-incompatible kidney transplantation

AU - Lee, Juhan

AU - Lee, Jae Geun

AU - Kim, Sinyoung

AU - Song, Seung Hwan

AU - Kim, Beom Seok

AU - Kim, Hyun Ok

AU - Kim, Myoung Soo

AU - Kim, Soon Il

AU - Kim, YuSeun

AU - Huh, Kyu Ha

PY - 2016/6/24

Y1 - 2016/6/24

N2 - Background Rituximab (RIT) improves the outcomes of ABO-incompatible (ABOi) kidney transplantation (KT), but it has been associated with infectious complications. The aim of this study was to investigate infectious complications according to the dose of RIT in ABOi KT. MethodsWe analyzed 213 recipients [118 ABO-compatible (ABOc) KT and 95 ABOi KT] who underwent living donor KT between 2010 and 2014. ABOi KT patients were categorized by RIT dose: standard RIT (375 mg/m 2 , n = 76) versus reduced RIT (200 mg, n = 19). All patients received basiliximab and maintained on triple immunosuppression consisting of tacrolimus, prednisone and mycophenolate mofetil. Infectious complications and post-transplant outcomes were analyzed for 1 year following KT. ResultsThe rates of overall infectious complications among the three groups were comparable (22.9% in ABOc KT, 38.2% in standard RIT and 26.3% in reduced RIT, P = 0.069). In the standard RIT group, hepatitis B virus reactivation occurred in three recipients (3.9%) with hepatitis B surface antigen[-]/anti-hepatitis B core antibody[+]. Three cases (3.9%) of Pneumocystis jirovecii pneumonia occurred in the standard RIT group. Serious infections developed in 13 of the ABOc KT (11.0%), 20 from the standard RIT group (26.3%) and 2 from the reduced RIT group (10.5%, P = 0.015). Standard-dose RIT was found to be an independent risk factor for serious infections [hazard ratio: 2.59 (95% confidence interval: 1.33-5.07), P = 0.005]. There were no significant differences in rejection, renal function, graft survival and patient survival between standard and reduced RIT groups. ConclusionsStandard RIT increased the risk of serious infection when compared with reduced-dose RIT. Reduced-dose RIT might be sufficient for ABOi KT without increasing the risk of serious infection.

AB - Background Rituximab (RIT) improves the outcomes of ABO-incompatible (ABOi) kidney transplantation (KT), but it has been associated with infectious complications. The aim of this study was to investigate infectious complications according to the dose of RIT in ABOi KT. MethodsWe analyzed 213 recipients [118 ABO-compatible (ABOc) KT and 95 ABOi KT] who underwent living donor KT between 2010 and 2014. ABOi KT patients were categorized by RIT dose: standard RIT (375 mg/m 2 , n = 76) versus reduced RIT (200 mg, n = 19). All patients received basiliximab and maintained on triple immunosuppression consisting of tacrolimus, prednisone and mycophenolate mofetil. Infectious complications and post-transplant outcomes were analyzed for 1 year following KT. ResultsThe rates of overall infectious complications among the three groups were comparable (22.9% in ABOc KT, 38.2% in standard RIT and 26.3% in reduced RIT, P = 0.069). In the standard RIT group, hepatitis B virus reactivation occurred in three recipients (3.9%) with hepatitis B surface antigen[-]/anti-hepatitis B core antibody[+]. Three cases (3.9%) of Pneumocystis jirovecii pneumonia occurred in the standard RIT group. Serious infections developed in 13 of the ABOc KT (11.0%), 20 from the standard RIT group (26.3%) and 2 from the reduced RIT group (10.5%, P = 0.015). Standard-dose RIT was found to be an independent risk factor for serious infections [hazard ratio: 2.59 (95% confidence interval: 1.33-5.07), P = 0.005]. There were no significant differences in rejection, renal function, graft survival and patient survival between standard and reduced RIT groups. ConclusionsStandard RIT increased the risk of serious infection when compared with reduced-dose RIT. Reduced-dose RIT might be sufficient for ABOi KT without increasing the risk of serious infection.

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