Rituximab in the treatment of acute cellular rejection of renal allograft with CD20-positive clusters in the infiltrate
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Jorge Vega Helmuth Goecke Alejandra Carrasco Carlos Escobar Max Escobar Roberto Espinosa Gonzalo Me´ndez Mar´a de los A ´ ngeles Rodr´
- چاپ و سال / کشور: 2011
Description
A 31-year-old woman with nephronophthisis received a cadaveric kidney transplant, and was immunosuppressed with cyclosporine, azathioprine and steroids. Twelve days after transplant a biopsy showed acute rejection with vascular damage. She was treated with 3 pulses of methylprednisolone and change of immunosuppression to mycophenolate mofetil and tacrolimus, without improving graft function. At day 21, a second biopsy showed accentuation of interstitial and vascular rejection. Antibodymediated rejection was suspected and plasmapheresis and rituximab were prescribed. Graft function improved rapidly. Staining for C4d was negative and there were no circulating antibodies against the donor. In the interstitial infiltrate there were clusters of B lymphocytes that accounted for 40% of cells, which was thought to be an ominous sign, as it has been associated with poor graft outcome. Acute T-cell-mediated rejection grade III (Banff 07) was diagnosed. Thirty-nine months after transplant her kidney function is stable with no other complication. This clinical case generates the hypothesis that rituximab may have a beneficial role in the therapy of acute cellular rejection when there are clusters of B lymphocytes in the infiltrate and a good response has not been obtained to conventional anti-rejection therapy
Clin Exp Nephrol (2011) 15:308–311, Received: 25 July 2010 / Accepted: 15 November 2010 / Published online: 10 December 2010 Japanese Society of Nephrology 2010
