本邦膵臓移植症例におけるrituximab（遺伝子組換え）に関する使用実態調査の結果—膵移植後rituximab使用4症例の報告—

抄録

【Objectives】 This is a second survey conducted with the aim of understanding the actual situation of rituximab use in pancreas transplantation in Japan after a first survey for all organ transplantation.

【Methods】 A second survey on efficacy and safety was conducted, which included 4 cases from 3 institutions in which rituximab was used for the treatment of antibody-related rejection after pancreas transplantation from August 2001 through December 2016.

【Results】 Although pancreatic graft biopsies were not performed in any case, kidney graft biopsy was performed in 3 cases for the diagnosis of AMR. After the diagnosis of rejection, two were positive for DSA class II, and two were positive for both DSA class I and II. As a treatment for AMR, one patient received 50 mg/m² of rituximab, and the other three patients received 200 mg/body. The pancreatic graft prognosis after AMR was graft loss in 3 of the 4 cases. As an adverse event after AMR treatment, antigenemia due to cytomegalovirus (n＝1) and bone marrow suppression (n＝2) were observed as adverse events; however, none of these adverse events was serious and all cases recovered.

【Conclusion】 AMR after pancreas transplantation was associated with a poor pancreatic graft prognosis. However, treatment with rituximab has shown the potential to control AMR and avoid graft loss.

In addition, no fatal adverse events were observed, and the incidence of complications, such as viral infection, was not high.