Open AccessRituximab in renal transplantation
Author(s) -
Barnett A. Nicholas R.,
Hadjianastassiou Vassilis G.,
Mamode Nizam
Publication year - 2013
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.12072
Subject(s) - rituximab , medicine , transplantation , immunology , cytokine release syndrome , neutropenia , lymphoproliferative disorders , cd20 , kidney transplantation , alemtuzumab , monoclonal antibody , antibody , post transplant lymphoproliferative disorder , lymphoma , t cell , immune system , chemotherapy , chimeric antigen receptor
Summary Rituximab is a chimeric anti‐ CD 20 monoclonal antibody that leads to B cell depletion. It is not licensed for use in renal transplantation but is in widespread use in ABO blood group incompatible transplantation. It is an effective treatment for post‐transplant lymphoproliferative disorder, and is also used in both HLA antibody incompatible renal transplantation and the treatment of acute rejection. Recent evidence suggests rituximab may prevent the development of chronic antibody mediated rejection. The mechanisms underlying its effects are likely to relate both to long‐term effects on plasma cell development and to the impact on B cell modulation of T cell responses. Rituximab (in multiple doses or in combination with other monoclonal antibodies and/or other immunosuppressants) may lead to an increase in infectious complications, although the evidence is not clear. Rarely, the drug can cause a cytokine release syndrome, thrombocytopenia and neutropenia. It has been related to an increased risk of progressive multifocal leucoencephalopathy and, recently, deaths from cardiovascular causes. Trials examining the effects of rituximab in induction therapy for compatible renal transplantation and the treatment of chronic antibody mediated rejection are ongoing. These trials should aid greater understanding of the role of B ‐cells in the alloresponse to renal transplantation.