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The effect of rituximab dose on infectious complications in ABO-incompatible kidney transplantation.

Authors
 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 
Citation
 NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol.31(6) : 1013-1021, 2016 
Journal Title
NEPHROLOGY DIALYSIS TRANSPLANTATION
ISSN
 0931-0509 
Issue Date
2016
MeSH
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*
Keywords
ABO incompatibility ; desensitization ; infection ; kidney transplantation ; rituximab
Abstract
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.
Full Text
http://ndt.oxfordjournals.org/content/31/6/1013
DOI
10.1093/ndt/gfw017
Appears in Collections:
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
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myoung Soo(김명수) ORCID logo https://orcid.org/0000-0002-8975-8381
Kim, Beom Seok(김범석) ORCID logo https://orcid.org/0000-0002-5732-2583
Kim, Soon Il(김순일) ORCID logo https://orcid.org/0000-0002-0783-7538
Kim, Sin Young(김신영) ORCID logo https://orcid.org/0000-0002-2609-8945
Kim, Yu Seun(김유선) ORCID logo https://orcid.org/0000-0002-5105-1567
Kim, Hyun Ok(김현옥) ORCID logo https://orcid.org/0000-0002-4964-1963
Song, Seung Hwan(송승환)
Lee, Jae Geun(이재근) ORCID logo https://orcid.org/0000-0002-6722-0257
Huh, Kyu Ha(허규하) ORCID logo https://orcid.org/0000-0003-1364-6989
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/146888
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