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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  ;  Yu Seun Kim  ;  Kyu Ha Huh 
 Nephrology Dialysis Transplantation, Vol.31(6) : 1013-1021, 2016 
Journal Title
 Nephrology Dialysis Transplantation 
Issue Date
ABO Blood-Group System/immunology* ; Adult ; Blood Group Incompatibility/complications* ; Blood Group Incompatibility/immunology ; Dose-Response Relationship, Drug ; Female ; Graft Survival ; Humans ; Immunologic Factors/administration & dosage ; Immunosuppression/methods* ; Kidney Transplantation/adverse effects* ; Male ; Middle Aged ; Risk Factors ; Rituximab/administration & dosage* ; Surgical Wound Infection/drug therapy*
ABO incompatibility ; desensitization ; infection ; kidney transplantation ; rituximab
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. METHODS: We 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. RESULTS: The 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. CONCLUSIONS: Standard 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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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
Yonsei Authors
김명수(Kim, Myoung Soo) ORCID logo https://orcid.org/0000-0002-8975-8381
김범석(Kim, Beom Seok) ORCID logo https://orcid.org/0000-0002-5732-2583
김순일(Kim, Soon Il) ORCID logo https://orcid.org/0000-0002-0783-7538
김신영(Kim, Sin Young) ORCID logo https://orcid.org/0000-0002-2609-8945
김유선(Kim, Yu Seun) ORCID logo https://orcid.org/0000-0002-5105-1567
김현옥(Kim, Hyun Ok) ORCID logo https://orcid.org/0000-0002-4964-1963
송승환(Song, Seung Hwan)
이재근(Lee, Jae Geun) ORCID logo https://orcid.org/0000-0002-6722-0257
허규하(Huh, Kyu Ha) ORCID logo https://orcid.org/0000-0003-1364-6989
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