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- W2077403940 abstract "To the Editor: We thank Tyden et al. for their comments on our recent paper. In this article, we found an increased risk of infectious disease after rituximab therapy, and the combination of rituximab and T-cell-depleting agents was an independent factor for infection mortality after kidney transplantation (1Kamar N Milioto O Puissant-Lubrano B et al.Incidence and predictive factors for infectious disease after rituximab therapy in kidney-transplant patients.Am J Transplant. 2010; 10: 89-98Abstract Full Text Full Text PDF PubMed Scopus (146) Google Scholar). First, Tyden et al. were surprised by the infection rates observed in the rituximab- and non-rituximab-treated groups. However, in one of their previous studies, which compared the outcome of ABO-incompatible kidney transplantation using antigen-specific immunoadsorption, a single dose of rituximab (375 mg/m2) and intravenous immunoglobulin with ABO-compatible living donor-kidney recipients receiving conventional immunosuppressive therapy, their rates of infection that required in-hospital care were, respectively, 40% and 63.3% (2Genberg H Kumlien G Wennberg L Berg U Tyden G ABO-incompatible kidney transplantation using antigen-specific immunoadsorption and rituximab: A 3-year follow-up.Transplantation. 2008; 85: 1745-1754Crossref PubMed Scopus (153) Google Scholar). Furthermore, in a randomized, placebo-controlled study, where a single dose of rituximab was the induction therapy in ABO-compatible kidney-transplant patients, bacterial infection rates were found to be 62% in the rituximab group and 76% in the placebo group (3Tyden G Genberg H Tollemar J et al.A randomized, double blind, placebo-controlled, study of single-dose rituximab as induction in renal transplantation.Transplantation. 2009; 87: 1325-1329Crossref PubMed Scopus (118) Google Scholar). Hence, the rates of infection from these two studies are actually similar to those observed in our report. Recently, two other research groups have reported infection rates similar to ours in kidney-transplant patients receiving rituximab (4Tsapepas DS, Aull MJ, Dadhnia D, Kapur S. Risk of infection in kidney-transplant recipients treated with rituximab. Am J Transplant 2008; 9: 564 (Abstract 1452).Google Scholar, 5Scemla A, Thervet E, Martinez F et al. Safety of rituximab therapy for prevention or treatment of acute humoral rejection after renal transplantation. Am J Transplant 2009; 9(Suppl 2): 558 (Abstract 1317).Google Scholar). Second, as acknowledged by Tyden et al., in our study we used rituximab as rescue therapy rather than as single-dose induction therapy, as used in their studies (2Genberg H Kumlien G Wennberg L Berg U Tyden G ABO-incompatible kidney transplantation using antigen-specific immunoadsorption and rituximab: A 3-year follow-up.Transplantation. 2008; 85: 1745-1754Crossref PubMed Scopus (153) Google Scholar, 3Tyden G Genberg H Tollemar J et al.A randomized, double blind, placebo-controlled, study of single-dose rituximab as induction in renal transplantation.Transplantation. 2009; 87: 1325-1329Crossref PubMed Scopus (118) Google Scholar). Therefore, these important variables differed between these studies. Tyden et al. showed that a single dose of rituximab induced profound peripheral B cell depletion and partial reduction in B cell counts in lymph nodes (6Genberg H Hansson A Wernerson A Wennberg L Tyden G Pharmacodynamics of rituximab in kidney allotransplantation.Am J Transplant. 2006; 6: 2418-2428Crossref PubMed Scopus (149) Google Scholar). They also showed that a single dose of rituximab resulted in complete elimination of B cells in kidney allograft tissue (6Genberg H Hansson A Wernerson A Wennberg L Tyden G Pharmacodynamics of rituximab in kidney allotransplantation.Am J Transplant. 2006; 6: 2418-2428Crossref PubMed Scopus (149) Google Scholar). However, in their study, among the analyzed kidney tissues, only four biopsies were obtained from three patients who had experience an antibody-mediated rejection: surprisingly, a kidney biopsy was not obtained from any of their patients when acute rejection was diagnosed (6Genberg H Hansson A Wernerson A Wennberg L Tyden G Pharmacodynamics of rituximab in kidney allotransplantation.Am J Transplant. 2006; 6: 2418-2428Crossref PubMed Scopus (149) Google Scholar). Hence, it is still unknown whether a single dose of rituximab is efficient for treating acute or chronic humoral rejection. Furthermore, induction therapy with a single dose of rituximab in kidney transplant patients did not add any beneficial effect when compared to placebo. Thus, further studies are required to determine the optimal dose of rituximab in the setting of ‘rescue therapy’. Finally, we agree with Tyden and colleagues that a randomized controlled clinical trial should be performed. However, we completely disagree that lessons cannot be drawn from retrospective studies, even when the patients’ matching is not optimal because of the rarity and severity of humoral rejection. Retrospective studies can be used to establish hypotheses for prospective studies and to draw the attention of physicians to the use of potent immunosuppressants such as T-cell-depleting agents, rituximab and bortezomib. We encourage other groups to report their infection rates when using these potent immunosuppressant combinations as rescue or induction therapy in patients with positive cross-matches and/or donor-specific antibodies." @default.
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- W2077403940 date "2010-08-01" @default.
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- W2077403940 title "Infection After Rituximab Therapy in Kidney-Transplant Patients" @default.
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