Rituximab as treatment for refractory kidney transplant rejection
Rituximab as treatment for refractory kidney transplant rejection
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DOI：
10.1111/j.1600-6143.2004.00454.x
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发表时间：
2004-06-01
影响因子：
8.8
通讯作者：
Sollinger, HW
中科院分区：
文献类型：
--
作者：
Becker, YT;Becker, BN;Sollinger, HW
最近的研究表明，高密度的CD20+细胞出现在有类固醇抵抗性排斥反应的患者身上。利妥昔单抗是一种高亲和力的CD-20特异性抗体，在诱导细胞凋亡的同时抑制B细胞的增殖。因此，清除B细胞介导的事件是移植治疗的合理选择。1999年2月至2002年2月，27例患者被诊断为经活检证实的排斥反应，表现为血栓性微血管病变和/或血管内皮炎。这些患者除了接受其他治疗外，还接受了单剂量的利妥昔单抗治疗，以努力扭转他们的排斥反应。24名患者接受了额外的类固醇治疗，而27名患者中有22名还接受了血浆置换和抗胸腺细胞球蛋白(ATG)治疗。在随访期(605+/-335.3天)中，只有3名患者发生了与患者死亡无关的移植物丢失。在24名成功治疗的患者中，利妥昔单抗治疗开始时的血肌酐为5.6+/-1.0 mg/dL，出院时降至0.95+/-0.7 mg/dL。加入利妥昔单抗可改善肾移植后严重的类固醇耐药或抗体介导的排斥反应的预后。
Recent studies have shown that a high density of CD 20+ cells are seen in patients who have steroid-resistant rejection episodes. Rituximab is a high-affinity CD-20 specific antibody that inhibits B-cell proliferation while inducing cellular apoptosis. Thus, it is a rational choice for therapy in transplantation to abrogate B-cell-mediated events.Twenty-seven patients were diagnosed with biopsy-confirmed rejection manifested by thrombotic microangiopathy and/or endothelialitis between 2/99 and 2/02 at our institution. These individuals were treated with a single dose of rituximab, in addition to other therapies, in an effort to reverse their rejection episodes. Twenty-four received additional steroids while 22 of the 27 patients were also treated with plasmapheresis and antithymocyte globulin (ATG). Only three patients experienced graft loss not associated with patient death during the follow-up period (605+/-335.3 days). In the 24 successfully treated patients, the serum creatinine at the time of initiating rituximab therapy was 5.6+/-1.0 mg/dL and decreased to 0.95+/-0.7 mg/dL at discharge.The addition of rituximab may improve outcomes in severe, steroid-resistant or antibody-mediated rejection episodes after kidney transplantation.