Rituximab therapy for de novo mixed cryoglobulinemia in renal transplant patients
Rituximab therapy for de novo mixed cryoglobulinemia in renal transplant patients
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DOI：
10.1097/01.tp.0000183749.79424.b4
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发表时间：
2005-12-15
期刊：
影响因子：
6.2
通讯作者：
Rostaing, L
中科院分区：
文献类型：
--
作者：
Basse, G;Ribes, D;Rostaing, L
背景11型或III型cryopulins在肾移植（RT）患者中相当普遍，并且通常与慢性丙型肝炎病毒（HCV）感染有关。然而，它们很少导致移植物功能障碍。它们由寡克隆B细胞的增殖维持。已经在HCV阳性免疫活性患者中用与CD 20抗原特异性反应的人/小鼠嵌合单克隆抗体（即，利妥昔单抗）。因此，这提供了使用利妥昔单抗治疗RT患者中cryobulin相关移植物功能障碍的基本原理。3例RT患者，其中1例为HCV阳性，在移植后很长时间内出现肾功能损害，以及新发肾病综合征（n = 2）和重度高血压（n = 2）。后一种情况与III型冷球蛋白血症有关，并与膜增生性肾小球肾炎有关。除基线标准免疫抑制外，患者每周输注375 mg/m2利妥昔单抗（患者2次输注，另外2例4次输注）。这种治疗导致了肾脏参数的显着改善，特别是在肾病综合征的持续缓解，持续清除cryopulins在两个案件，但也在两个案件的严重感染并发症。我们的结论是，利妥昔单抗治疗是非常有效的cryopulin相关的肾功能不全的RT患者，但是，由于慢性免疫抑制，这是在感染并发症的代价。
Background. Type 11 or III cryoglobulins are fairly prevalent in renal-transplant (RT) patients, and are often related to chronic hepatitis C virus (HCV) infection. However, they rarely result in graft dysfunction. They are sustained by proliferation of oligoclonal B-cells. Systemic B-cell depletion and clinical remission of the systemic effects of cryoglobulins have been achieved in HCV-positive immunocompetent patients with a human/mouse chimeric monoclonal antibody that specifically reacts with the CD20 antigen (i.e., rituximab). Thus, this provides the rationale to use rituximab for cryoglobulin-related graft dysfunction in RT patients.Methods. Three RT patients, of whom one was HCV-positive, developed renal-function impairment long after transplantation, as well as de novo nephrotic syndrome (n = 2) and severe hypertension (n = 2). This latter case was related to type III cryoglobulinemia and was associated with membranoproliferative glomerulonephritis. In addition to their baseline standard immunosuppression, the patients were given weekly rituximab infusions of 375 mg/m(2) (two infusions in patient and four infusions for the other two cases).Results. This treatment resulted in a dramatic improvement in renal parameters, particularly in a sustained remittence of nephrotic syndrome, a sustained clearance of cryoglobulins in two cases, but also in severe infectious complications in two cases.Conclusion. We conclude that rituximab therapy is highly effective in cryoglobulin-related renal dysfunction in RT patients; however, due to chronic immunosuppression, this is at the expense of infectious complications.