ISSN: 2251-8363    eISSN: 2251-8819  
J Nephropathol. 2018;7(3):151-157.
doi:10.15171/jnp.2018.34

Original Article

Rituximab and hypogammaglobulinemia in the setting of ABO-incompatible kidney transplantation

Hamza Naciri Bennani 1, Zhyiar Abdulraham 1, Bénédicte Puissant-Lubrano 2, Asma Allal 1, Lionel Rostaing 1,3,4 *

1 Département de Néphrologie et Transplantation d’Organes, CHU Toulouse, France
2 Laboratoire d’Immunologie, CHU Toulouse, France
3 Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation, CHU Grenoble-Alpes, France
4 Université Joseph Fourier, Grenoble Alpes, France
*Corresponding author: Lionel Rostaing, MD, PhD, Email: lrostaing@chu-grenoble.fr

Abstract

Background: ABO-incompatible (ABOi) kidney transplantation can be achieved by desensitizing the recipient using apheresis plus rituximab-based immunosuppression.

Objectives: We sought to ascertain the factors that contributed to low immunoglobulin levels at post-ABOi kidney transplantation.

Patients and Methods: This single-center study included 43 ABO-i kidney-transplant recipients desensitized with rituximab-based therapy. Posttransplant immunoglobulin levels (IgG, IgA, and IgM) were prospectively monitored within 2 years. If severe hypogammaglobulinemia occurred, i.e., IgG levels <4 g/L, patients received polyvalent
immunoglobulin (IVIg substitution).

Results: Within 1-year posttransplantation, 25% of patients experienced at least once severe hypogammaglobulinemia. On D –30 (pre-transplantation), IgG, IgA, and IgM levels were within normal ranges: 10 ± 4.4, 1.9 ± 1.2, and 0.8± 0.5 g/L, respectively. IgG levels were significantly decreased at D0 (4.2 ± 3.8 g/L) compared to D–30. At D15, IgG levels did not significantly differ from those on D0 or D –30. Conversely, beyond month-1 posttransplant IgG levels were within normal ranges and were significantly higher than levels measured on D0. Within three months posttransplantation, 11 patients required IVIg because IgG levels were <4 g/L (IVIg+ group). When these patients were compared with those that did not receive IVIg within 3 months posttransplantation (IVIg– group), IgG levels were similar at D –30 in both groups. Conversely, at D0, IgG levels were significantly lower in the Ig+ group (2.4 ± 2 vs. 5.5± 4.2 g/L; P = 0.009); t he d ifference remained significant
until D15 posttransplantation (Ig+: 3.4 ± 1.7, Ig–: 6.6 ± 2 g/L; P = 0.0002). There was no statistical difference between the two groups after D15. Infectious complications did not significantly vary between patients with or without hypogammaglobulinemia.

Conclusions: We conclude that hypogammaglobulinemia occurred frequently after ABOincompatible kidney transplantation but did not cause more infectious complications.

Implication for health policy/practice/research/medical education:

ABO incompatible kidney transplantation is widely accepted, and results in very good long-term results provided pretransplant desensitization. The latter relies on rituximab therapy that might result in hypogammaglobulinemia. Herein, we demonstrate that hypogammaglobulinemia is frequent after ABO incompatible kidney transplantation, i.e. in 25% of patients. However, immunoglobulin substitution, i.e. by infusing IVIg in cases of severe hypogammaglobulinemia (< 4 g/L) prevents posttranplant infectious complications.

Please cite this paper as: Naciri Bennani H, Abdulraham Z, Puissant-Lubrano B, Allal A, Rostaing L. Rituximab and hypogammaglobulinemia in the setting of ABO-incompatible kidney transplantation. J Nephropathol. 2018;7(3):151-157. DOI: 10.15171/jnp.2018.34.

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Submitted: 09 Jun 2017

Accepted: 10 Sep 2017
First published online: 28 Sep 2017
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