Use of anti-CD20 antibody in the treatment of post-transplant glomerulonephritis

Post-transplant glomerulonephritis (PTGN) accounts for 4-10% of late graft loss. Six consecutive patients who developed PTGN 3-72months post-transplant presented to our center with deteriorating kidney function and proteinuria. Three had focal segmental glomerulosclerosis; one had membranoproliferative glomerulonephritis Type 1; one recurrent membranous nephropathy; and one recurrent immunoglobin A nephropathy. All six were treated with an aggressive immunosuppression regimen including rituximab, pulse steriods and/or maximization of mycophenolic acid and calcineurin inhibitor therapy. Four of the six patients received plasma exchange. The patients were followed for a minimum of ninemonths after treatment. Proteinuria decreased from 7.2±4.4 to 1.4±1.5g (p=0.04), while mean estimated glomerular filtration rate was 31.2±13.1 and 42.5±21.7mL/min (p=0.07) at ninemonths. No adverse events were noted. These observations suggest that immune modulating therapy may be of benefit in the treatment of PTGN.