BACKGROUND AND OBJECTIVES: Rituximab and intravenous Ig (IVIG) are commonly used for desensitization of HLA and blood group-incompatible (ABOi) transplants. However, serious infections have been noted in association with rituximab administration. In this study, we retrospectively compared infectious outcomes in those who received rituximab plus IVIG for HLA or ABOi transplants (RIT group) with a group of nonsensitized, ABO-compatible transplant recipients (non-RIT group). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Patients undergoing kidney transplantation at Cedars-Sinai Medical Center were included in the analysis. A total of 361 patients were identified. All received antimicrobial prophylaxis and viral surveillance. The primary outcome was infection. RESULTS: Overall patient survival was 97 and 96%, and graft survival was 91 and 89% in the RIT and non-RIT groups, respectively, after an average follow-up of 18 months. There were equal rates of bacterial (34.7% versus 39.1%), viral (21.8% versus 25.1%), fungal (5.9% versus 5.2%), and serious infections (22.9% versus 25.5%) in the RIT and non-RIT groups respectively. Urinary tract infection was the most common infection, accounting for 50% of all bacterial infections. Cytomegalovirus viremia was nonsignificantly more common in the nonrituximab-treated group (15.2% versus 10%), whereas BK viremia was marginally more frequent in the rituximab-treated group (10.6% versus 5.8%). There were no graft losses caused by BK-associated nephropathy. There were two deaths in each group related to infection (1%). CONCLUSION: Rituximab does not increase infection risk when used with intravenous Ig for desensitization.
BACKGROUND AND OBJECTIVES:Rituximab and intravenous Ig (IVIG) are commonly used for desensitization of HLA and blood group-incompatible (ABOi) transplants. However, serious infections have been noted in association with rituximab administration. In this study, we retrospectively compared infectious outcomes in those who received rituximab plus IVIG for HLA or ABOi transplants (RIT group) with a group of nonsensitized, ABO-compatible transplant recipients (non-RIT group). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Patients undergoing kidney transplantation at Cedars-Sinai Medical Center were included in the analysis. A total of 361 patients were identified. All received antimicrobial prophylaxis and viral surveillance. The primary outcome was infection. RESULTS: Overall patient survival was 97 and 96%, and graft survival was 91 and 89% in the RIT and non-RIT groups, respectively, after an average follow-up of 18 months. There were equal rates of bacterial (34.7% versus 39.1%), viral (21.8% versus 25.1%), fungal (5.9% versus 5.2%), and serious infections (22.9% versus 25.5%) in the RIT and non-RIT groups respectively. Urinary tract infection was the most common infection, accounting for 50% of all bacterial infections. Cytomegalovirus viremia was nonsignificantly more common in the nonrituximab-treated group (15.2% versus 10%), whereas BK viremia was marginally more frequent in the rituximab-treated group (10.6% versus 5.8%). There were no graft losses caused by BK-associated nephropathy. There were two deaths in each group related to infection (1%). CONCLUSION:Rituximab does not increase infection risk when used with intravenous Ig for desensitization.
Authors: Christopher J Sonnenday; Daniel S Warren; Mathew Cooper; Milagros Samaniego; Mark Haas; Karen E King; R Sue Shirey; Christopher E Simpkins; Robert A Montgomery Journal: Am J Transplant Date: 2004-08 Impact factor: 8.086
Authors: G Basse; D Ribes; N Kamar; M Mehrenberger; F Sallusto; L Esposito; J Guitard; L Lavayssière; F Oksman; D Durand; L Rostaing Journal: Transplant Proc Date: 2006-09 Impact factor: 1.066
Authors: F Leroy; A Sechet; R Abou Ayache; A Thierry; S Belmouaz; E Desport; M Bauwens; F Bridoux; G Touchard Journal: Transplant Proc Date: 2006-09 Impact factor: 1.066
Authors: Shellee A Grim; Thuy Pham; James Thielke; Howard Sankary; Jose Oberholzer; Enrico Benedetti; Nina M Clark Journal: Clin Transplant Date: 2007 Sep-Oct Impact factor: 2.863
Authors: Babak J Orandi; Xun Luo; Elizabeth A King; Jacqueline M Garonzik-Wang; Sunjae Bae; Robert A Montgomery; Mark D Stegall; Stanley C Jordan; Jose Oberholzer; Ty B Dunn; Lloyd E Ratner; Sandip Kapur; Ronald P Pelletier; John P Roberts; Marc L Melcher; Pooja Singh; Debra L Sudan; Marc P Posner; Jose M El-Amm; Ron Shapiro; Matthew Cooper; George S Lipkowitz; Michael A Rees; Christopher L Marsh; Bashir R Sankari; David A Gerber; Paul W Nelson; Jason Wellen; Adel Bozorgzadeh; A Osama Gaber; Dorry L Segev Journal: Am J Transplant Date: 2017-09-23 Impact factor: 8.086
Authors: Kristin C Turza; Michael Shafique; Peter I Lobo; Robert G Sawyer; Douglas S Keith; Kenneth L Brayman; Avinash Agarwal Journal: Surg Infect (Larchmt) Date: 2014-04-28 Impact factor: 2.150
Authors: Irene K Kim; Jua Choi; Ashley A Vo; Alexis Kang; Mitasha Patel; Mieko Toyoda; James Mirocha; Elaine S Kamil; J Louis Cohen; Sabrina Louie; Odette Galera; Stanley C Jordan; Dechu P Puliyanda Journal: Transplantation Date: 2017-04 Impact factor: 4.939
Authors: Betti Schaefer; Burkhard Tönshoff; Jan Schmidt; Mohammad Golriz; Arianeb Mehrabi; Petra Gombos; Christian Morath; Elke Wühl; Franz Schaefer; Claus Peter Schmitt Journal: Pediatr Nephrol Date: 2012-09-09 Impact factor: 3.714
Authors: Steven E Lipshultz; Jayanthi J Chandar; Paolo G Rusconi; Alessia Fornoni; Carolyn L Abitbol; George W Burke; Gaston E Zilleruelo; Si M Pham; Elena E Perez; Ruchika Karnik; Juanita A Hunter; Danielle D Dauphin; James D Wilkinson Journal: Clinics (Sao Paulo) Date: 2014 Impact factor: 2.365