ABO 혈액형 부적합 신장이식에서 Rituximab의 고용량 투여군과 저용량 투여군의 효과 및 안전성 비교 분석

Abstract

Background : ABO incompatible (ABOi) kidney transplantation has become an effective option to resolve organ shortage. In Korea, in 2015, the number of patients who received kidney transplantation was 1,891; among them, the number of ABOi kidney transplantation was 450. To ensure successful ABOi kidney transplantation, rituximab is used to reduce acute antibody-mediated rejection (AMR). However, the adequate rituximab dosage in ABOi kidney transplantation remains undetermined; therefore, this study aimed to evaluate the effective dose of rituximab. Methods : From July 2012 to June 2015, we conducted a chart review in a total of 53 ABOi kidney transplantation recipients, who took rituximab before the transplantation at Severance Hospital. The immunosuppressive protocol consisted of tacrolimus, mycophenolate mofetil, and corticosteroids. The pre-conditioning protocol included double-filtration plasmapheresis and a single dose of rituximab. We classified the study population into two groups, i.e., the high dose rituximab group (375 mg/m2 rituximab, n=27) and the low dose rituximab group (200 mg/body rituximab, n=26). Information on the incidence of AMR, infection and neutropenia, reduction of anti A/B antibody titer, peripheral CD19 and CD20 levels, and population characteristic were collected from the medical records. Results : The incidence of AMR was 7.4% in the high dose rituximab group vs. 15.4% in the low dose rituximab group (P=0.42). Effective reduction of the anti A/B antibody titer and elimination of the peripheral blood CD19 and CD20 levels were observed in both groups. However, the infectious complications and incidence of late onset neutropenia (LON) were more common in the high dose rituximab group (29.6% vs. 15.4%, P=0.22; 40.7% vs. 0.0%, P 0.001). Conclusion : The results were similar in patients in the low dose rituximab group as compared to patients in the high dose rituximab group. These results suggested that the low dose of rituximab(200 mg/body) is sufficient in cases with ABOi kidney transplantation.