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. 2017 Jul 25:22:455-462.
doi: 10.12659/aot.902236.

Acute Cellular Rejection in ABO-Incompatible Renal Transplant Recipients Receiving Rituximab Is Associated with Delayed-Onset Neutropenia

Junji Uchida  1 , Tomoaki Iwai  1 , Shunji Nishide  1 , Kazuya Kabei  1 , Nobuyuki Kuwabara  1 , Takeshi Yamasaki  1 , Toshihide Naganuma  1 , Norihiko Kumada  2 , Yoshiaki Takemoto  1 , Tatsuya Nakatani  1
Affiliations

Acute Cellular Rejection in ABO-Incompatible Renal Transplant Recipients Receiving Rituximab Is Associated with Delayed-Onset Neutropenia

Junji Uchida et al. Ann Transplant. .

Abstract

BACKGROUND Rituximab induces long-lasting B cell depletion in the peripheral blood and increases the levels of proinflammatory cytokines associated with regulatory B cell depletion. Previous reports showed that B cell-related cytokine release after administration of rituximab may induce acute cellular rejection (ACR) and delayed-onset neutropenia. The present study was conducted to investigate the correlation between acute rejection and delayed-onset neutropenia in ABO-incompatible renal transplant recipients who underwent administration of rituximab for 1 year after transplantation. MATERIAL AND METHODS From June 2006 to July 2015, 47 patients with chronic renal failure received ABO-incompatible renal transplant with rituximab induction at Osaka City University Hospital. All 47 patients underwent plasmapheresis due to removal of anti-A/B antibodies and administration of rituximab, and their transplants were carried out successfully. We investigated the correlation between ACR and delayed-onset neutropenia in ABO-incompatible renal transplant recipients who underwent administration of rituximab for 1 year after transplantation. RESULTS Fourteen patients (29.8%) experienced ACR (group A), and 33 recipients did not develop ACR (group B). The frequency of delayed-onset neutropenia was higher in group A than in group B (p=0.0503). Multivariate logistic regression analysis revealed that the frequency of ACR correlated significantly with the prevalence of delayed-onset neutropenia. CONCLUSIONS Our results indicated that ACR in ABO-incompatible renal transplant recipients receiving rituximab was associated with delayed-onset neutropenia.

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Figures

Figure 1
Figure 1
Standard protocol for ABO-incompatible kidney transplantation without splenectomy. MMF – mycophenolate mofetil; PE – plasma exchange; DFPP – double filtration plasmapheresis.
Figure 2
Figure 2
High-titer protocol for ABO-incompatible high-titer (more than 1: 512) kidney transplantation. MMF – mycophenolate mofetil; PE – plasma exchange; DFPP – double-filtration plasmapheresis.
Figure 3
Figure 3
Elderly protocol for ABO-incompatible kidney transplantation without splenectomy in elderly recipients. MMF – mycophenolate mofetil; PE – plasma exchange; DFPP – double-filtration plasmapheresis.
Figure 4
Figure 4
Modified standard protocol for ABO-incompatible kidney transplantation without splenectomy. MMF – mycophenolate mofetil; PE – plasma exchange; DFPP – double-filtration plasmapheresis.
See this image and copyright information in PMC

References

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