Rituximab is not a “magic drug” in post-transplant recurrence of nephrotic syndrome

• DOI: 10.1007/s00431-016-2747-1
• Publication Date: 2016-06-30T21:15:19Z
• Authors: Ryszard Grenda; Wioletta Jarmużek; Jacek Rubik; Barbara Piątosa; Sylwester Prokurat
• Keywords: Male; Nephrotic Syndrome; Remission Induction; Lung Injury; Kidney Transplantation; 3. Good health; 03 medical and health sciences; Postoperative Complications; 0302 clinical medicine; Recurrence; Child, Preschool; Humans; Immunologic Factors; Kidney Failure, Chronic; Original Article; Female; Pediatrics, Perinatology, and Child Health; Child; Rituximab; Lung; Retrospective Studies

Pediatric patients with end-stage renal failure due to severe drug-resistant nephrotic syndrome are at risk of rapid recurrence after transplantation. Treatment options include plasmapheresis, high-dose cyclosporine A/methylprednisolone and more recently-rituximab (anti-B CD20 monoclonal depleting antibody). We report five immediate (1-2 days) post-transplant syndrome, treated this kind combined therapy including 2-4 weekly doses 375 mg/m(2) rituximab. Only two (of five) have showed full long-term remission, while the partial remission was seen in cases, no clinical effect all achieved one patient. The correlation between B CD19 cells depletion present cases only. Severe adverse events were patients, fatal rituximab-related acute lung injury.The anti-CD20 antibody may be not effective pediatric benefit/risk ratio must carefully balanced on individual basis before taking decision use protocol.• recur immediately transplantation • plasmapheresis pharmacotherapy is used as rescue management rituximab reported drug both primary What New: several variety underlying mechanisms disease, which or responsive there drug-induced specific effect; might suggest B-cell independent manner action.