Rituximab in renal transplantation

A. Nicholas R Barnett, Vassilis G. Hadjianastassiou, Nizam Mamode

Research output: Contribution to journalReview articlepeer-review

54 Citations (Scopus)

Abstract

Rituximab is a chimeric anti-CD20 monoclonal antibody that leads to B cell depletion. It is not licensed for use in renal transplantation but is in widespread use in ABO blood group incompatible transplantation. It is an effective treatment for post-transplant lymphoproliferative disorder, and is also used in both HLA antibody incompatible renal transplantation and the treatment of acute rejection. Recent evidence suggests rituximab may prevent the development of chronic antibody mediated rejection. The mechanisms underlying its effects are likely to relate both to long-term effects on plasma cell development and to the impact on B cell modulation of T cell responses. Rituximab (in multiple doses or in combination with other monoclonal antibodies and/or other immunosuppressants) may lead to an increase in infectious complications, although the evidence is not clear. Rarely, the drug can cause a cytokine release syndrome, thrombocytopenia and neutropenia. It has been related to an increased risk of progressive multifocal leucoencephalopathy and, recently, deaths from cardiovascular causes. Trials examining the effects of rituximab in induction therapy for compatible renal transplantation and the treatment of chronic antibody mediated rejection are ongoing. These trials should aid greater understanding of the role of B-cells in the alloresponse to renal transplantation.

Original languageEnglish
Pages (from-to)563-575
Number of pages13
JournalTransplant International
Volume26
Issue number6
DOIs
Publication statusPublished - Jun 2013

Keywords

  • B-lymphocytes
  • CD20 antigens
  • graft rejection
  • immunosuppression
  • kidney transplantation
  • monoclonal antibodies

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