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: A case report

S. Miyagi, S. Sekiguchi, N. Kawagishi, Y. Akamatsu, K. Satoh, I. Takeda, D. Fukushima, Y. Kobayashi, K. Tokodai, K. Fujimori, S. Satomi

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)3299-3301
Number of pages3
JournalTransplantation Proceedings
Volume43
Issue number9
DOIs
Publication statusPublished - 2011 Nov 1

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Fingerprint Dive into the research topics of '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: A case report'. Together they form a unique fingerprint.

Cite this