肺移植後の抗体関連拒絶に対するrituximab（遺伝子組換え）

抄録

【Objective】 We retrospectively surveyed the details of treatment with rituximab for antibody-mediated rejection (AMR) after lung transplantation.

【Design】 Case series.

【Methods】 This study was conducted to assess outcomes in patients who underwent lung transplantation in Japan from August 2001 to December 2016 and were treated with rituximab for AMR. A questionnaire was sent to medical institutions that had used rituximab for such treatment, and information on AMR treatment, including rituximab dosage, efficacy, and safety, was collected.

【Results】 Among the 525 patients undergoing lung transplantation during the study period in Japan, fourteen patients (2.7%; 1 child and 13 adults) were enrolled. Records showed definite clinical AMR in 3 patients, probable clinical AMR in 2 patients, possible clinical AMR in 8 patients and suspected AMR in 1 patient. All patients had allograft dysfunction, and 13 adult patients were positive for donor-specific antibodies (DSA). Two patients experienced rejection more than twice. Rituximab was administered to all patients. In one patient who experienced AMR twice, rituximab was administered for each AMR. The rituximab dose was 375 mg/m² in all but one patient, who received 348 mg/m². Eight patients recovered from AMR. AMR treatments, including rituximab, were well tolerated. However, 11 patients developed graft loss due to rejection, and 10 patients died from chronic lung allograft syndrome or sepsis.

【Conclusion】 Based on these findings, treatment containing rituximab was considered effective for AMR, but careful monitoring is needed to prevent or reduce the number of adverse events such as infection.