Treatment of symptomatic transplant glomerulopathy with rituximab

Abstract

Kidney transplant glomerulopathy (TG) has a poor outcome as there are no known effective therapies. Therefore, we investigated whether rituximab therapy (RTx) could halt progression of established TG. Fourteen kidney‐transplant patients (nine of whom were men), with median age of 54 (range: 30–74) years, of whom seven had biologic markers for HCV infection, underwent a kidney biopsy (KB) at 118 months post‐transplant because of impaired allograft function, associated with albuminuria (95–13430 mg/day), within nephrotic‐range albuminuria in seven patients. KBs showed no evidence of acute cellular rejection but showed TG. Donor‐specific anti‐HLA antibodies were present in six cases. When diagnosis of TG was made, patients were placed on rituximab therapy (RTx) (2–4 injections of 375 mg/m² week), and other concurrent immunosuppression treatments were not modified. By last follow up post‐RTx (30 months), seven (50%) patients had lost their kidney within 6–26 months and the other seven had stable creatinine (182 vs. 161 μmol/l; NS), and albuminuria had decreased from 2660 to 500 mg/day (P = 0.03). There was prolonged B‐cell lymphopenia (from 71 to 0/mm³) whereas immunoglobulin G, A, M levels remained stable, and four patients (28.5%) experienced severe infectious complications. We conclude that long‐term RTx in kidney‐transplant patients with TG is associated with allograft function/stabilization in 50% of cases.