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Incidence and Predictive Factors for Infectious Disease after Rituximab Therapy in Kidney‐Transplant Patients
Author(s) -
Kamar N.,
Milioto O.,
PuissantLubrano B.,
Esposito L.,
Pierre M. C.,
Mohamed A. Ould,
Lavayssière L.,
Cointault O.,
Ribes D.,
Cardeau I.,
Nogier M. B.,
Durand D.,
Abbal M.,
Blancher A.,
Rostaing L.
Publication year - 2010
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2009.02785.x
Subject(s) - rituximab , medicine , transplantation , kidney transplantation , incidence (geometry) , population , immunology , maintenance therapy , mortality rate , gastroenterology , chemotherapy , lymphoma , physics , environmental health , optics
Rituximab off‐label use includes organ transplantation. We review the occurrence of infectious disease and its outcome after rituximab therapy. Between April 2004 and August 2008, 77 kidney‐transplant patients received rituximab therapy [2–8 courses (median 4) of 375 mg/m 2 each] for various reasons. Their results were compared with a control group (n = 902) who had received no rituximab. After a median follow‐up of 16.5 (1–55) months for rituximab patients and 60.9 (1.25–142.7) months for control patients, the incidence of infectious disease was 45.45% and 53.9% (ns), respectively. The incidence of bacterial infection was similar between the two groups, whereas the viral‐infection rate was significantly lower, and the rate of fungal infection was significantly higher in the rituximab group. Nine out of 77 patients (11.68%) died after rituximab therapy, of which seven deaths (9.09%) were related to an infectious disease, compared to 1.55% in the controls (p = 0.0007). In the whole population, the independent predictive factors for infection‐induced death were the combined use of rituximab and antithymocyte‐globulin given for induction or anti‐rejection therapy, recipient age, and bacterial and fungal infections. After kidney transplantation, the use of rituximab is associated with a high risk of infectious disease and death related to infectious disease.