Abstract
Background. Rituximab is becoming increasingly utilized in renal transplant recipients; however, its association with infections remains unclear. Methods. We reviewed the incidence of viral and fungal infections in kidney transplant recipients treated with () or without () rituximab (RTX) in addition to standard immunosuppression. Results. Infections occurred in 134 (30%) patients, with a greater proportion in RTX versus no RTX patients (47% versus 28%; ). Viral infections occurred in 44% and 27% of RTX and no RTX patients, respectively (). This was largely driven by the frequency of BK viremia and noncytomegalovirus/non-BK viruses in RTX patients (27% versus 13% () and 15% versus 2% (), resp.). Fungal infections also occurred more often in RTX patients (11% versus 3 %; ). Multivariate analysis revealed deceased donor recipient (odds ratio = 2.5; ) and rituximab exposure (odds ratio = 2.2; ) as independent risk factors for infection. Older patients, deceased donor recipients, those on dialysis longer, and those with delayed graft function tended to be at a greater risk for infections following rituximab. Conclusions. Rituximab is associated with an increased incidence of viral and fungal infections in kidney transplantation. Additional preventative measures and/or monitoring infectious complications may be warranted in those receiving rituximab.
Highlights
The anti-CD20 monoclonal antibody rituximab (RTX) has become a more widely utilized therapy in the renal transplant population
RTX use has expanded from treatment of posttransplant lymphoproliferative disease to facilitation of ABO-incompatible transplantation, reduction of human leukocyte antigen (HLA) antibodies in highly sensitized patients, treatment of antibody mediated rejection (AMR), and treatment of recurrent and de novo renal diseases [1,2,3,4]
Viral infections occurred more frequently in the RTX group compared to the not exposed to RTX (no RTX) group (44% versus 27%; P = 0.012), owing primarily to a higher rate of BK virus and other nonCMV/non-BK viral infections (Figure 1(a))
Summary
The anti-CD20 monoclonal antibody rituximab (RTX) has become a more widely utilized therapy in the renal transplant population. RTX use has expanded from treatment of posttransplant lymphoproliferative disease to facilitation of ABO-incompatible transplantation, reduction of human leukocyte antigen (HLA) antibodies in highly sensitized patients, treatment of antibody mediated rejection (AMR), and treatment of recurrent and de novo renal diseases [1,2,3,4]. Each of these conditions represents a significant challenge in renal transplantation by which B-cell depletion with RTX may represent a promising intervention. We reviewed the incidence of viral and fungal infections in kidney transplant recipients treated with (n = 55) or without (n = 386) rituximab (RTX) in addition to standard immunosuppression. Additional preventative measures and/or monitoring infectious complications may be warranted in those receiving rituximab
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