Use of anti-CD20 antibody in the treatment of post-transplant glomerulonephritis

Clin Transplant. May-Jun 2011;25(3):375-9. doi: 10.1111/j.1399-0012.2010.01245.x. Epub 2010 Apr 5.

Abstract

Post-transplant glomerulonephritis (PTGN) accounts for 4-10% of late graft loss. Six consecutive patients who developed PTGN 3-72 months post-transplant presented to our center with deteriorating kidney function and proteinuria. Three had focal segmental glomerulosclerosis; one had membranoproliferative glomerulonephritis Type 1; one recurrent membranous nephropathy; and one recurrent immunoglobin A nephropathy. All six were treated with an aggressive immunosuppression regimen including rituximab, pulse steroids and/or maximization of mycophenolic acid and calcineurin inhibitor therapy. Four of the six patients received plasma exchange. The patients were followed for a minimum of nine months after treatment. Proteinuria decreased from 7.2 ± 4.4 to 1.4 ± 1.5g (p = 0.04), while mean estimated glomerular filtration rate was 31.2 ± 13.1 and 42.5 ± 21.7 mL/min (p = 0.07) at nine months. No adverse events were noted. These observations suggest that immune modulating therapy may be of benefit in the treatment of PTGN.

MeSH terms

  • Antibodies, Anti-Idiotypic / therapeutic use*
  • Antibodies, Monoclonal, Murine-Derived / therapeutic use*
  • Antigens, CD20 / immunology
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Glomerulonephritis / etiology
  • Glomerulonephritis / immunology
  • Glomerulonephritis / therapy*
  • Humans
  • Immunologic Factors / therapeutic use*
  • Kidney Failure, Chronic / surgery*
  • Kidney Function Tests
  • Kidney Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Plasmapheresis
  • Postoperative Complications*
  • Prognosis
  • Proteinuria / etiology
  • Proteinuria / immunology
  • Proteinuria / therapy
  • Risk Factors
  • Rituximab
  • Survival Rate

Substances

  • Antibodies, Anti-Idiotypic
  • Antibodies, Monoclonal, Murine-Derived
  • Antigens, CD20
  • Immunologic Factors
  • Rituximab