Effects of Rituximab on the Development of Viral and Fungal Infections in Renal Transplant Recipients

• Published in: ISRN Transplantation Vol. 2013; pp. 1 - 8
• Main Authors: Patel, Samir J., Devos, Jennifer M., Knight, Richard J., Dawson, Kyle L., Suki, Wadi N., Gonzalez, Juan M., Abdellatif, Abdul A., Gaber, A. Osama
• Format: Journal Article
• Language: English
• Published: Hindawi Publishing Corporation 03.11.2013
• ISSN: 2314-4092; 2314-4092
• DOI: 10.5402/2013/819025

Background. Rituximab is becoming increasingly utilized in renal transplant recipients; however, its association with infections remains unclear. Methods. We reviewed the incidence of viral and fungal infections in kidney transplant recipients treated with (n=55) or without (n=386) rituximab (RTX) in addition to standard immunosuppression. Results. Infections occurred in 134 (30%) patients, with a greater proportion in RTX versus no RTX patients (47% versus 28%; P=0.005). Viral infections occurred in 44% and 27% of RTX and no RTX patients, respectively (P=0.012). This was largely driven by the frequency of BK viremia and noncytomegalovirus/non-BK viruses in RTX patients (27% versus 13% (P=0.011) and 15% versus 2% (P<0.001), resp.). Fungal infections also occurred more often in RTX patients (11% versus 3 %; P=0.009). Multivariate analysis revealed deceased donor recipient (odds ratio = 2.5; P<0.001) and rituximab exposure (odds ratio = 2.2; P=0.016) as independent risk factors for infection. Older patients, deceased donor recipients, those on dialysis longer, and those with delayed graft function tended to be at a greater risk for infections following rituximab. Conclusions. Rituximab is associated with an increased incidence of viral and fungal infections in kidney transplantation. Additional preventative measures and/or monitoring infectious complications may be warranted in those receiving rituximab.