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25 July 2017 : Original article  

Acute Cellular Rejection in ABO-Incompatible Renal Transplant Recipients Receiving Rituximab Is Associated with Delayed-Onset Neutropenia

Junji Uchida1ACE*, Tomoaki Iwai1BD, Shunji Nishide1BDF, Kazuya Kabei1BCD, Nobuyuki Kuwabara1B, Takeshi Yamasaki1BF, Toshihide Naganuma1AE, Norihiko Kumada2BCF, Yoshiaki Takemoto1AE, Tatsuya Nakatani1AF

DOI: 10.12659/AOT.902236

Ann Transplant 2017; 22:455-462

Abstract

BACKGROUND: Rituximab induces long-lasting B cell depletion in the peripheral blood and increases the levels of proinflammatory cytokines associated with regulatory B cell depletion. Previous reports showed that B cell-related cytokine release after administration of rituximab may induce acute cellular rejection (ACR) and delayed-onset neutropenia. The present study was conducted to investigate the correlation between acute rejection and delayed-onset neutropenia in ABO-incompatible renal transplant recipients who underwent administration of rituximab for 1 year after transplantation.

MATERIAL AND METHODS: From June 2006 to July 2015, 47 patients with chronic renal failure received ABO-incompatible renal transplant with rituximab induction at Osaka City University Hospital. All 47 patients underwent plasmapheresis due to removal of anti-A/B antibodies and administration of rituximab, and their transplants were carried out successfully. We investigated the correlation between ACR and delayed-onset neutropenia in ABO-incompatible renal transplant recipients who underwent administration of rituximab for 1 year after transplantation.

RESULTS: Fourteen patients (29.8%) experienced ACR (group A), and 33 recipients did not develop ACR (group B). The frequency of delayed-onset neutropenia was higher in group A than in group B (p=0.0503). Multivariate logistic regression analysis revealed that the frequency of ACR correlated significantly with the prevalence of delayed-onset neutropenia.

CONCLUSIONS: Our results indicated that ACR in ABO-incompatible renal transplant recipients receiving rituximab was associated with delayed-onset neutropenia.

Keywords: ABO Blood-Group System, Graft Rejection, Kidney Transplantation, Neutropenia

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358