Publication: Comparative long-term renal allograft outcomes of recurrent immunoglobulin a with severe activity in kidney transplant recipients with and without rituximab: An observational cohort study
Issued Date
2021-09-01
Resource Type
ISSN
20770383
Other identifier(s)
2-s2.0-85114030323
Rights
Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Clinical Medicine. Vol.10, No.17 (2021)
Suggested Citation
Wiwat Chancharoenthana, Asada Leelahavanichkul, Wassawon Ariyanon, Somratai Vadcharavivad, Weerapong Phumratanaprapin Comparative long-term renal allograft outcomes of recurrent immunoglobulin a with severe activity in kidney transplant recipients with and without rituximab: An observational cohort study. Journal of Clinical Medicine. Vol.10, No.17 (2021). doi:10.3390/jcm10173939 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/77897
Research Projects
Organizational Units
Authors
Journal Issue
Thesis
Title
Comparative long-term renal allograft outcomes of recurrent immunoglobulin a with severe activity in kidney transplant recipients with and without rituximab: An observational cohort study
Abstract
Recurrent IgA nephropathy (IgAN) remains an important cause of allograft loss in renal transplantation. Due to the limited efficacy of corticosteroid in the treatment of recurrent glomeru-lonephritis, rituximab was used in kidney transplant (KT) recipients with severe recurrent IgAN. A retrospective cohort study was conducted between January 2015 and December 2020. Accordingly, there were 64 KT recipients with biopsy-proven recurrent IgAN with similar baseline characteristics that were treated with the conventional standard therapy alone (controls, n = 43) or together with rituximab (cases, n = 21). All of the recipients had glomerular endocapillary hypercellularity and proteinuria (>1 g/d) with creatinine clearance (CrCl) > 30 mL/min/1.73 m2 and well-controlled blood pressure using renin–angiotensin–aldosterone blockers. The treatment outcomes were renal allograft survival rate, proteinuria, and post-treatment allograft pathology. During 3.8 years of follow-up, the rituximab-based regimen rapidly decreased proteinuria within 12 months after rituximab administration and maintained renal allograft function—the primary endpoint—for approximately 3 years. There were eight recipients in the case group (38%), and none in the control group reached a complete remission (proteinuria < 250 mg/d) at 12 months after treatment. Notably, renal allograft histopathology from patients with rituximab-based regimen showed the less severe endocapillary hypercellularity despite the remaining strong IgA deposition. In conclusion, adjunctive treatment with rituximab potentially demonstrated favorable outcomes for treatment of recurrent severe IgAN post-KT as demonstrated by proteinuria reduction and renal allograft function in our cohort. Further in-depth mechanistic studies with the longer follow-up periods are recommended.