Refractory acute kidney transplant rejection with CD20 graft infiltrates and successful therapy with rituximab
Refractory acute kidney transplant rejection with CD20 graft infiltrates and successful therapy with rituximab
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DOI：
10.1111/j.1399-0012.2004.00292.x
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发表时间：
2005-02-01
影响因子：
2.1
通讯作者：
Hariharan, S
中科院分区：
文献类型：
--
作者：
Alausa, M;Almagro, U;Hariharan, S
急性排斥反应是移植后的预期事件，并与长期肾移植结局不良相关。在急性排斥反应的肾移植物中存在B细胞被认为是一个普遍的迹象，因为它与移植物预后不良有关。对于移植物中B细胞的急性排斥反应，目前还没有确定的治疗方法。利妥昔单抗（Rituximab）是一种抗CD 20的人源化单克隆抗体，已被用于治疗B细胞淋巴瘤。我们报告一例49岁的白种男性，早期急性肾移植排斥反应，高剂量类固醇和兔抗胸腺细胞球蛋白（胸腺球蛋白）无效。重复肾活检显示移植肾中存在T细胞和B细胞，并对利妥昔单抗和莫罗单抗（一种抗CD 3受体的小鼠单克隆抗体）的组合有反应。移植后9个月，患者保持无排斥反应，血清肌酐为1.7 mg/dL。
Acute rejection is an expected event after transplantation and has been associated with poor long-term kidney transplant outcome. The presence of B cells in the kidney graft with acute rejection is thought to be an omnious sign, as it has been associated with poor graft outcome. There is no definitive treatment for acute rejection with B cells in the graft. Rituximab, a humanized monoclonal antibody against CD20, has been used in the treatment of B cell lymphoma. We present the case of a 49-yr-old Caucasian male with early acute kidney allograft rejection that was refractory to high doses of steroids and rabbit anti-thymocyte globulin (thymoglobulin). Repeat renal biopsy revealed T cell and B cells in the kidney graft and responded to the combination of rituximab and muromonab (a mouse monoclonal antibody to CD3 receptor). Over 9 months post-transplant, the patient remains rejection free with a serum creatinine of 1.7 mg/dL.