TY - JOUR
T1 - Rituximab therapy and reduction of immunosuppression to rescue graft function after renal posttransplantation lymphoproliferative disorder found by macrohematuria in a pancreas and kidney transplant recipient
T2 - A case report
AU - Miyagi, S.
AU - Sekiguchi, S.
AU - Kawagishi, N.
AU - Akamatsu, Y.
AU - Satoh, K.
AU - Takeda, I.
AU - Fukushima, D.
AU - Kobayashi, Y.
AU - Tokodai, K.
AU - Fujimori, K.
AU - Satomi, S.
N1 - Funding Information:
Funding: Grants-in-Aid for Scientific Research from the Ministry of Education, Science, and Culture of Japan and the Ministry of Welfare of Japan and a grant from Tohoku University Graduate School of Medicine .
PY - 2011/11
Y1 - 2011/11
N2 - Introduction: Posttransplantation lymphoproliferative disorder (PTLD) remains an uncommon complication of solid organ transplantation, with a high mortality rate reported after conventional therapies. Epstein-Barr virus (EBV) may cause PTLD, but most EBV infections after transplantation are clinically silent reactivations, so the detection of PTLD is often delayed. Recently we experienced the rare case of intrarenal graft PTLD found by macrohematuria in a simultaneous pancreas and kidney transplant recipient. The grafts were saved by treatments with rituximab, cyclophosphamide, hydroxydaunorubicin, and prednisonebased chemotherapy (R-CHOP) after reduction of immunosuppression (IR). Methods: This 37-year-old man with insulin-dependent diabetes underwent simultaneous pancreas and kidney transplantation (SPK) with enteric drainage. Six months after transplantation, he displayed macrohematuria, which we investigated by blood tests, computer tomography (CT) scan, positron emission tomography (PET)CT, and magnetic resonance imaging, recognizing a tumor in the transplanted renal graft. An open biopsy showed a CD20-positive PTLD. We started treatments with IR, rituximab (375 mg/m2, weekly for 2 cycles) and R-CHOP therapy: rituximab (375 mg/m2) plus CHOP every 3 weeks for 6 cycles. Results: IR and R-CHOP therapy achieved a complete remission (CR). CR has continued for 14 months at the time of writing. The maximum level of EBV DNA was 259 copies/μg DNA, but 2 months after these therapies, the level had decreased to normal. The patient had no impairment of pancreas and kidney graft functions. Conclusions: The outcome of intragraft PTLD in the kidney of an SPK recipient suggested that the negative impact of IR on graft function may be compensated by the immunosuppressive effects of rituximab, allowing reduced immunosuppression during chemotherapy.
AB - Introduction: Posttransplantation lymphoproliferative disorder (PTLD) remains an uncommon complication of solid organ transplantation, with a high mortality rate reported after conventional therapies. Epstein-Barr virus (EBV) may cause PTLD, but most EBV infections after transplantation are clinically silent reactivations, so the detection of PTLD is often delayed. Recently we experienced the rare case of intrarenal graft PTLD found by macrohematuria in a simultaneous pancreas and kidney transplant recipient. The grafts were saved by treatments with rituximab, cyclophosphamide, hydroxydaunorubicin, and prednisonebased chemotherapy (R-CHOP) after reduction of immunosuppression (IR). Methods: This 37-year-old man with insulin-dependent diabetes underwent simultaneous pancreas and kidney transplantation (SPK) with enteric drainage. Six months after transplantation, he displayed macrohematuria, which we investigated by blood tests, computer tomography (CT) scan, positron emission tomography (PET)CT, and magnetic resonance imaging, recognizing a tumor in the transplanted renal graft. An open biopsy showed a CD20-positive PTLD. We started treatments with IR, rituximab (375 mg/m2, weekly for 2 cycles) and R-CHOP therapy: rituximab (375 mg/m2) plus CHOP every 3 weeks for 6 cycles. Results: IR and R-CHOP therapy achieved a complete remission (CR). CR has continued for 14 months at the time of writing. The maximum level of EBV DNA was 259 copies/μg DNA, but 2 months after these therapies, the level had decreased to normal. The patient had no impairment of pancreas and kidney graft functions. Conclusions: The outcome of intragraft PTLD in the kidney of an SPK recipient suggested that the negative impact of IR on graft function may be compensated by the immunosuppressive effects of rituximab, allowing reduced immunosuppression during chemotherapy.
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U2 - 10.1016/j.transproceed.2011.10.002
DO - 10.1016/j.transproceed.2011.10.002
M3 - Article
C2 - 22099782
AN - SCOPUS:81455132413
SN - 0041-1345
VL - 43
SP - 3299
EP - 3301
JO - Transplantation Proceedings
JF - Transplantation Proceedings
IS - 9
ER -
