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The efficacy and safety of high-dose mizoribine in ABO-incompatible kidney transplantation using anti-CD20 and anti-CD25 antibody without splenectomy treatment.
- Source :
-
Transplantation proceedings [Transplant Proc] 2012 Jan; Vol. 44 (1), pp. 140-3. - Publication Year :
- 2012
-
Abstract
- Background: Mizoribine (MZR) has been developed as an immunosuppressive agent in Japan, but it shows less potent immunosuppressive effects at doses up to 3 mg/kg/d. In this study, we investigated whether high-dose MZR (6 mg/kg/d) was effective for ABO-incompatible (ABO-i) living donor kidney transplantation (LKT) using treatment with anti-CD25 and anti-CD20 monoclonal antibodies without splenectomy.<br />Methods: Since 2007, we encountered 24 cases of ABO-i LKT using anti-CD20 and anti-CD25 monoclonal antibody without splenectomy. The pretransplant immunosuppressive regimen consisted of two doses of anti-CD20 antibody, mycophenolate mofetil (MMF), prednisolone, a calcineurin inhibitor (cyclosporine [7 mg/kg] or tacrolimus [0.2 mg/kg] and two doses of anti-CD25 antibody. Antibody removal by plasmapheresis was performed before LKT up to several times according to the antibody titer. The posttransplant regimen consisted of high-dose mizoribine (6 mg/kg/d) instead of MMF (MZR group, n = 12).<br />Results: The 1-year graft survival rates for the MZR and MMF groups were both 100%. The rejection rate in the MZR group (eight %) was not significantly higher than that in the MMF group (seventeen %) Serum creatinine level was not significantly different between the two groups. In the MZR group 6 (50%) patients developed CMV antigenemia-positivity versus 11 (92%) in the MMF group (P < .05). The number of patients who developed CMV disease was 0 in the MZR group and 1 (8%) in the MMF group. The number of patients treated with ganciclovir was 0% and 8%, respectively (not significant).<br />Conclusions: We obtain good clinical results with high-dose MZR in ABO-i LKT using anti-CD20 and anti-CD25 antibody treatment without splenectomy.<br /> (Copyright © 2012 Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Antibodies, Monoclonal adverse effects
Antibodies, Monoclonal, Murine-Derived adverse effects
Antigens, CD20 immunology
Antiviral Agents therapeutic use
Basiliximab
Biomarkers blood
Creatinine blood
Cytomegalovirus Infections drug therapy
Cytomegalovirus Infections immunology
Drug Therapy, Combination
Female
Graft Rejection immunology
Graft Rejection prevention & control
Graft Survival drug effects
Humans
Immunosuppressive Agents adverse effects
Interleukin-2 Receptor alpha Subunit immunology
Japan
Kaplan-Meier Estimate
Living Donors
Male
Middle Aged
Recombinant Fusion Proteins adverse effects
Ribonucleosides adverse effects
Rituximab
Time Factors
Treatment Outcome
Young Adult
ABO Blood-Group System immunology
Antibodies, Monoclonal therapeutic use
Antibodies, Monoclonal, Murine-Derived therapeutic use
Blood Group Incompatibility immunology
Histocompatibility
Immunosuppressive Agents therapeutic use
Kidney Transplantation adverse effects
Kidney Transplantation immunology
Recombinant Fusion Proteins therapeutic use
Ribonucleosides therapeutic use
Splenectomy
Subjects
Details
- Language :
- English
- ISSN :
- 1873-2623
- Volume :
- 44
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Transplantation proceedings
- Publication Type :
- Academic Journal
- Accession number :
- 22310599
- Full Text :
- https://doi.org/10.1016/j.transproceed.2011.12.009