Kidney Week

Abstract: FR-PO890

CD19+ Cell Behavior in the 12 Months Following a Single Dose of Rituximab in Patients with Humoral Rejection: Clinical and Histological Outcomes

Session Information

• Transplantation: Translational and Transplant Pathology
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Martinez, Itzel Anahi, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico

Itzel Anahi Martinez,

• Marino sanchez, José roberto, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico

José roberto Marino sanchez,

• Trujeque, Mariedel, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico

Mariedel Trujeque,

• Santander, Jesus Ivan, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico

Jesus Ivan Santander,

• Zamora-Mejia, Flor M., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico

Flor M. Zamora-Mejia,

• Juárez-Contreras, Hilda, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico

Hilda Juárez-Contreras,

• Vazquez, Raquel Aracely, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico

Raquel Aracely Vazquez,

• Llorente Peters, Luis, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico

Luis Llorente Peters,

• Lima gonzalez, Guadalupe, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico

Guadalupe Lima gonzalez,

• Cohen-Bucay, Abraham, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico

Abraham Cohen-Bucay,

• Alberú, Josefina, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico

Josefina Alberú,

• Marino-Vazquez, Lluvia A., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico

Lluvia A. Marino-Vazquez,

• Morales-Buenrostro, Luis E., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico

Luis E. Morales-Buenrostro,

Background

Treatment of antibody mediated rejection (AMR) commonly includes rituximab (RTX). It has been suggested that a single dose of RTX is enough to deplete CD19+ cells. Aim: to analyze CD19+ cell behavior during the 12 months following a 500 mg dose of RTX and its correlation with clinical and histological outcomes.

Methods

Prospective cohort study of 122 kidney transplant recipients with biopsy proven AMR who received a single dose of RTX 500 mg as part of standard AMR treatment between 2012 and 2018. Peripheral CD19+ cells were measured at baseline, 15, 30, 90, 180, 270, and 360 days after RTX infusion, and correlated this data with clinical and histological outcomes.

Results

122 patients were included. Mean age was 35±13 y, 56.6% female, median time to rejection was 6y post-transplant. Treatment included PE and IVIG in 75%, 21% also received Bortezomib. All patients received 500 mg of RTX and were followed for a median of 21mo (0.1-83). Median allograft survival after AMR was 5.5y. CD19+ cell depletion (<10 cells) at 1mo was associated with less IFTA at follow-up biopsy (p=0.01) and improvement of proteinuria at last follow-up (p=0.05). Early CD19+ cell repopulation was associated with higher graft loss and dead (p=0.03). Persistent CD19+ cell depletion (<10 cells) at 12mo was associated with better graft and patient survival (0.04).

Conclusion

A single dose of RTX achieved CD19+ cell depletion in more than 80% of patients, which lasted at least 6 mo. CD19+ cell depletion is associated with improvement of proteinuria and less IFTA; and the persistence of CD19+ cell depletion at 12mo improves graft and patient survival.

CD19+ cell depletion patterns.