Rituximab and hypogammaglobulinemia in the setting of ABO-incompatible kidney transplantation
Background: ABO-incompatible (ABOi) kidney transplantation can be achieved by desensitizing the recipient using apheresis plus rituximab-based immunosuppression. Objectives: We sought to ascertain the factors that contributed to low immunoglobulin levels at post-ABOi kidney transplantation. Patients...
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| Format: | Article |
| Language: | English |
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Society of Diabetic Nephropathy Prevention
2018-07-01
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| Series: | Journal of Nephropathology |
| Subjects: | |
| Online Access: | https://nephropathol.com/PDF/jnp-7-151.pdf |
| _version_ | 1797827979625103360 |
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| author | Hamza Naciri Bennani Zhyiar Abdulraham Bénédicte Puissant-Lubrano Asma Allal Lionel Rostaing |
| author_facet | Hamza Naciri Bennani Zhyiar Abdulraham Bénédicte Puissant-Lubrano Asma Allal Lionel Rostaing |
| author_sort | Hamza Naciri Bennani |
| collection | DOAJ |
| description | Background: ABO-incompatible (ABOi) kidney transplantation can be achieved by desensitizing the recipient using apheresis plus rituximab-based immunosuppression. Objectives: We sought to ascertain the factors that contributed to low immunoglobulin levels at post-ABOi kidney transplantation. Patients and Methods: This single-center study included 43 ABO-i kidney-transplant recipients desensitized with rituximab-based therapy. Posttransplant immunoglobulin levels (IgG, IgA, and IgM) were prospectively monitored within 2 years. If severe hypogammaglobulinemia occurred, i.e., IgG levels <4 g/L, patients received polyvalent immunoglobulin (IVIg substitution). Results: Within 1-year posttransplantation, 25% of patients experienced at least once severe hypogammaglobulinemia. On D –30 (pre-transplantation), IgG, IgA, and IgM levels were within normal ranges: 10 ± 4.4, 1.9 ± 1.2, and 0.8± 0.5 g/L, respectively. IgG levels were significantly decreased at D0 (4.2 ± 3.8 g/L) compared to D–30. At D15, IgG levels did not significantly differ from those on D0 or D –30. Conversely, beyond month-1 posttransplant IgG levels were within normal ranges and were significantly higher than levels measured on D0. Within three months posttransplantation, 11 patients required IVIg because IgG levels were <4 g/L (IVIg+ group). When these patients were compared with those that did not receive IVIg within 3 months posttransplantation (IVIg– group), IgG levels were similar at D –30 in both groups. Conversely, at D0, IgG levels were significantly lower in the Ig+ group (2.4 ± 2 vs. 5.5± 4.2 g/L; P = 0.009); t he d ifference remained significant until D15 posttransplantation (Ig+: 3.4 ± 1.7, Ig–: 6.6 ± 2 g/L; P = 0.0002). There was no statistical difference between the two groups after D15. Infectious complications did not significantly vary between patients with or without hypogammaglobulinemia. Conclusions: We conclude that hypogammaglobulinemia occurred frequently after ABOincompatible kidney transplantation but did not cause more infectious complications. |
| first_indexed | 2024-04-09T12:57:07Z |
| format | Article |
| id | doaj.art-71b68683ab324712982debca4edeb4fc |
| institution | Directory Open Access Journal |
| issn | 2251-8363 2251-8819 |
| language | English |
| last_indexed | 2024-04-09T12:57:07Z |
| publishDate | 2018-07-01 |
| publisher | Society of Diabetic Nephropathy Prevention |
| record_format | Article |
| series | Journal of Nephropathology |
| spelling | doaj.art-71b68683ab324712982debca4edeb4fc2023-05-13T11:29:32ZengSociety of Diabetic Nephropathy PreventionJournal of Nephropathology2251-83632251-88192018-07-017315115710.15171/jnp.2018.34jnp-20180109105723Rituximab and hypogammaglobulinemia in the setting of ABO-incompatible kidney transplantationHamza Naciri Bennani0Zhyiar Abdulraham1Bénédicte Puissant-Lubrano2Asma Allal3Lionel Rostaing4Département de Néphrologie et Transplantation d’Organes, CHU Toulouse, FranceDépartement de Néphrologie et Transplantation d’Organes, CHU Toulouse, FranceLaboratoire d’Immunologie, CHU Toulouse, FranceDépartement de Néphrologie et Transplantation d’Organes, CHU Toulouse, FranceDépartement de Néphrologie et Transplantation d’Organes, CHU Toulouse, FranceBackground: ABO-incompatible (ABOi) kidney transplantation can be achieved by desensitizing the recipient using apheresis plus rituximab-based immunosuppression. Objectives: We sought to ascertain the factors that contributed to low immunoglobulin levels at post-ABOi kidney transplantation. Patients and Methods: This single-center study included 43 ABO-i kidney-transplant recipients desensitized with rituximab-based therapy. Posttransplant immunoglobulin levels (IgG, IgA, and IgM) were prospectively monitored within 2 years. If severe hypogammaglobulinemia occurred, i.e., IgG levels <4 g/L, patients received polyvalent immunoglobulin (IVIg substitution). Results: Within 1-year posttransplantation, 25% of patients experienced at least once severe hypogammaglobulinemia. On D –30 (pre-transplantation), IgG, IgA, and IgM levels were within normal ranges: 10 ± 4.4, 1.9 ± 1.2, and 0.8± 0.5 g/L, respectively. IgG levels were significantly decreased at D0 (4.2 ± 3.8 g/L) compared to D–30. At D15, IgG levels did not significantly differ from those on D0 or D –30. Conversely, beyond month-1 posttransplant IgG levels were within normal ranges and were significantly higher than levels measured on D0. Within three months posttransplantation, 11 patients required IVIg because IgG levels were <4 g/L (IVIg+ group). When these patients were compared with those that did not receive IVIg within 3 months posttransplantation (IVIg– group), IgG levels were similar at D –30 in both groups. Conversely, at D0, IgG levels were significantly lower in the Ig+ group (2.4 ± 2 vs. 5.5± 4.2 g/L; P = 0.009); t he d ifference remained significant until D15 posttransplantation (Ig+: 3.4 ± 1.7, Ig–: 6.6 ± 2 g/L; P = 0.0002). There was no statistical difference between the two groups after D15. Infectious complications did not significantly vary between patients with or without hypogammaglobulinemia. Conclusions: We conclude that hypogammaglobulinemia occurred frequently after ABOincompatible kidney transplantation but did not cause more infectious complications.https://nephropathol.com/PDF/jnp-7-151.pdfrituximababo-incompatiblekidney transplantationhypogammaglobulinemiainfections |
| spellingShingle | Hamza Naciri Bennani Zhyiar Abdulraham Bénédicte Puissant-Lubrano Asma Allal Lionel Rostaing Rituximab and hypogammaglobulinemia in the setting of ABO-incompatible kidney transplantation Journal of Nephropathology rituximab abo-incompatible kidney transplantation hypogammaglobulinemia infections |
| title | Rituximab and hypogammaglobulinemia in the setting of ABO-incompatible kidney transplantation |
| title_full | Rituximab and hypogammaglobulinemia in the setting of ABO-incompatible kidney transplantation |
| title_fullStr | Rituximab and hypogammaglobulinemia in the setting of ABO-incompatible kidney transplantation |
| title_full_unstemmed | Rituximab and hypogammaglobulinemia in the setting of ABO-incompatible kidney transplantation |
| title_short | Rituximab and hypogammaglobulinemia in the setting of ABO-incompatible kidney transplantation |
| title_sort | rituximab and hypogammaglobulinemia in the setting of abo incompatible kidney transplantation |
| topic | rituximab abo-incompatible kidney transplantation hypogammaglobulinemia infections |
| url | https://nephropathol.com/PDF/jnp-7-151.pdf |
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