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Impact of rituximab induction on short-term outcome of kidney transplant recipients
i n d i a n j o u r n a l o f t r a n s p l a n t a t i o n 8 ( 2 0 1 4 ) 1 2 6 e1 3 8
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25th Annual Conference of ISOT, Aurangabad, 2014 Impact of rituximab induction on short-term outcome of kidney transplant recipients Prashant Rajput, Bharat Shah, Shyam Pagar, Zaheer Virani, Amol Bhagat, Sushma Bala, Vijay Dawane Institute of Renal Sciences, Global Hospital, Mumbai, India Background: Acute graft rejection remains a major problem in renal transplant recipients. Induction with Thymoglobulin or basiliximab has significantly reduced the incidence of acute cellular rejection episodes. However, these induction agents do not eliminate the risk of antibody mediated rejection. Aim: To study efficacy and safety of single dose Rituximab in addition to single dose Thymoglobulin induction in kidney transplant patients. Methods: In the last 5 years, 164 patients underwent kidney transplant. Those with zero HLA mismatch (n ¼ 16) were excluded from analysis. Of the remaining 148 patients, 53 (35.8%) received no induction, 58 (39.2%) received single dose Thymoglobulin (1 mg/kg) and 37 (25%) received single dose Thymoglobulin and single dose Rituximab (200 mg) on the day of transplant. Maintenance immunosuppression included Tacrolimus, MMF and tapering doses of prednisolone in all. All patients received valgancyclovir and cotrimoxazole prophylaxis. The primary endpoint was defined as acute rejection, graft loss, or death during the first 3 months. Secondary endpoints were creatinine clearance, incidence of infections, and incidence of rituximab-related adverse event. Results: There was no difference in characteristics of patients in the 3 groups. There were 9 (16.9%) rejection episodes in no induction group, 7 (12.5%) rejection in Thymoglobulin group and 2 (5.4%) in Thymoglobulin+Rituximab group. Graft loss was seen in 2 (3.7%), 1 (1.7%) and none in the 3 groups, respectively. One patient died in no induction group while no patient died in other 2 groups. There was no difference in the number of bacterial infections, cytomegalovirus infections, BK virus infections or fungal infections. Creatinine clearance was 102 ± 19 mL/min, 94.4 ± 28.7 mL/min and 96.3 ± 21.6 mL/min in the 3 groups. There was no rituximab related adverse event. Conclusions: Rituximab induction is safe in kidney transplants. There is significant reduction in acute rejection episodes without increase in infectious complications.
Can pre-transplant serum levels of C4d and Bb be an indicator of rejection in kidney transplantation? Mukut Minza, Ravi Dhitalb, Ranjana W. Minze, c Vivekanand Jhaf, Chandigarh Ashish Sharma , Deepesh B. Kenward, Sarbpreet Singhd a Professor and Head, Department of Renal Transplant Surgery, PGIMER, Chandigarh, India b Ph.D Scholar, Department of Renal Transplant Surgery, PGIMER, Chandigarh, India c Additional Professor, Department of Renal Transplant Surgery, PGIMER, Chandigarh, India d Assistant Professor, Department of Renal Transplant Surgery, PGIMER, Chandigarh, India e Professor and Head, Department of Immunopathology, PGIMER, India f Professor, Department of Nephrology, PGIMER, Chandigarh, India Background: Activation of complement is a hallmark of rejection. Tissue deposition of C4d (activation product of complement factor C4) has been adopted by BANFF as a diagnostic criteria for AbMR. C4d in serum is a marker of complement activation via Classical Pathway while factor Bb (activation product of complement factor B) is a marker of complement activation by Alternative pathway. Purpose: To correlate the serum levels of complement split product C4d and Bb with transplant rejection in renal transplantation. Methodology: Out of total 110 transplants (Cadaveric, N ¼ 16; Live Related, N ¼ 57 and Live Unrelated, N ¼ 37), 27 biopsy proven transplant rejecters (Cellular, N ¼ 18; Antibody mediated, N ¼ 9) were compared with 10 nonrejecters (Cadaveric, N ¼ 1; Live Related, N ¼ 3 and Live unrelated, N ¼ 6) and 11 non transplant controls in terms of quantitation of serum C4d and Bb levels in serum by ELISA using Microvue complement EIA Kit for C4d and Bb Plus (Quidel Corporation, USA). The serum levels of C4d and Bb were recorded in terms of mg/mL. All patients received triple immunosuppression with Tacrolimus, Mycophenolate and Steroid. Statistical analysis was done using Graphpad Prism 5. Result: C4d and Bb levels in serum of patients with ESRD are higher than healthy controls (6.131 ± 0.4353 mg/mL). After transplantation, C4d levels reduce to levels comparable to healthy controls. Pre-transplant levels of C4d in non-rejecters
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/ijt
25th Annual Conference of ISOT, Aurangabad, 2014 Impact of rituximab induction on short-term outcome of kidney transplant recipients Prashant Rajput, Bharat Shah, Shyam Pagar, Zaheer Virani, Amol Bhagat, Sushma Bala, Vijay Dawane Institute of Renal Sciences, Global Hospital, Mumbai, India Background: Acute graft rejection remains a major problem in renal transplant recipients. Induction with Thymoglobulin or basiliximab has significantly reduced the incidence of acute cellular rejection episodes. However, these induction agents do not eliminate the risk of antibody mediated rejection. Aim: To study efficacy and safety of single dose Rituximab in addition to single dose Thymoglobulin induction in kidney transplant patients. Methods: In the last 5 years, 164 patients underwent kidney transplant. Those with zero HLA mismatch (n ¼ 16) were excluded from analysis. Of the remaining 148 patients, 53 (35.8%) received no induction, 58 (39.2%) received single dose Thymoglobulin (1 mg/kg) and 37 (25%) received single dose Thymoglobulin and single dose Rituximab (200 mg) on the day of transplant. Maintenance immunosuppression included Tacrolimus, MMF and tapering doses of prednisolone in all. All patients received valgancyclovir and cotrimoxazole prophylaxis. The primary endpoint was defined as acute rejection, graft loss, or death during the first 3 months. Secondary endpoints were creatinine clearance, incidence of infections, and incidence of rituximab-related adverse event. Results: There was no difference in characteristics of patients in the 3 groups. There were 9 (16.9%) rejection episodes in no induction group, 7 (12.5%) rejection in Thymoglobulin group and 2 (5.4%) in Thymoglobulin+Rituximab group. Graft loss was seen in 2 (3.7%), 1 (1.7%) and none in the 3 groups, respectively. One patient died in no induction group while no patient died in other 2 groups. There was no difference in the number of bacterial infections, cytomegalovirus infections, BK virus infections or fungal infections. Creatinine clearance was 102 ± 19 mL/min, 94.4 ± 28.7 mL/min and 96.3 ± 21.6 mL/min in the 3 groups. There was no rituximab related adverse event. Conclusions: Rituximab induction is safe in kidney transplants. There is significant reduction in acute rejection episodes without increase in infectious complications.
Can pre-transplant serum levels of C4d and Bb be an indicator of rejection in kidney transplantation? Mukut Minza, Ravi Dhitalb, Ranjana W. Minze, c Vivekanand Jhaf, Chandigarh Ashish Sharma , Deepesh B. Kenward, Sarbpreet Singhd a Professor and Head, Department of Renal Transplant Surgery, PGIMER, Chandigarh, India b Ph.D Scholar, Department of Renal Transplant Surgery, PGIMER, Chandigarh, India c Additional Professor, Department of Renal Transplant Surgery, PGIMER, Chandigarh, India d Assistant Professor, Department of Renal Transplant Surgery, PGIMER, Chandigarh, India e Professor and Head, Department of Immunopathology, PGIMER, India f Professor, Department of Nephrology, PGIMER, Chandigarh, India Background: Activation of complement is a hallmark of rejection. Tissue deposition of C4d (activation product of complement factor C4) has been adopted by BANFF as a diagnostic criteria for AbMR. C4d in serum is a marker of complement activation via Classical Pathway while factor Bb (activation product of complement factor B) is a marker of complement activation by Alternative pathway. Purpose: To correlate the serum levels of complement split product C4d and Bb with transplant rejection in renal transplantation. Methodology: Out of total 110 transplants (Cadaveric, N ¼ 16; Live Related, N ¼ 57 and Live Unrelated, N ¼ 37), 27 biopsy proven transplant rejecters (Cellular, N ¼ 18; Antibody mediated, N ¼ 9) were compared with 10 nonrejecters (Cadaveric, N ¼ 1; Live Related, N ¼ 3 and Live unrelated, N ¼ 6) and 11 non transplant controls in terms of quantitation of serum C4d and Bb levels in serum by ELISA using Microvue complement EIA Kit for C4d and Bb Plus (Quidel Corporation, USA). The serum levels of C4d and Bb were recorded in terms of mg/mL. All patients received triple immunosuppression with Tacrolimus, Mycophenolate and Steroid. Statistical analysis was done using Graphpad Prism 5. Result: C4d and Bb levels in serum of patients with ESRD are higher than healthy controls (6.131 ± 0.4353 mg/mL). After transplantation, C4d levels reduce to levels comparable to healthy controls. Pre-transplant levels of C4d in non-rejecters