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the recurrence of the vasculitis in the renal transplant treatment with Rituximab
RECIDIVA DE VASCULITIS EN TRASPLANTE RENAL TRATADA CON RITUXIMAB.
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Aránzazu Sastre López, Mariano Baños Gallardo, Miguel Seco*, Ernesto Gómez-Huertas
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The recurrence of the original renal disease in the renal transplant is relatively frequent.There are few series that describe the percentage of recurrences post-transplants of the ANCA vasculitis positive. In 1999, Nahman and cols., they base the percentage of recurrence of these vasculitis in post-transplants in 17,3%. The treatment of the recurrence of the vasculitis in the patients without transplant consists of the oral administration of bolus of 6-metilprednisolona and cyclophosphamide or I.V. in bolus. When the answer to the cyclophosphamide one is null or the indirect effect prevent their use, the monoclonal antibody anti-CD20 Rituximab has been used. Rituximab is a drug of recent approved introduction for the treatment of lymphomas B but that later has been used in the treatment of the humoral acute rejection in transplanted patients and multiple autoinmunes diseases. We presented the case of a transplanted patient renal diagnosed of vasculitis that received treatment with rituximab presenting a favourable evolution.
Keywords:
Renal transplant, vasculitis, rituximab
La recidiva de la enfermedad renal original en el trasplante renal es relativamente frecuente. Nahman y cols. cifran el porcentaje de recidiva de vasculitis ANCA+ en el 17,3%. El tratamiento estándar en los pacientes con o sin trasplante consiste en la administración de bolus de 6-metilprednisolona y ciclofosfamida oral o I.V. en bolus. Cuando la respuesta a la ciclofosfamida es nula o los efectos secundarios impiden su utilización, se ha empleado el anticuerpo monoclonal anti-CD20 Rituximab, una droga que actúa frente a los linfocitos B, por lo que se ha sido utilizado en el tratamiento del rechazo agudo humoral en enfermos trasplantados y en múltiples enfermedades autoinmunes. Se describe el caso de un paciente con trasplante renal de cadáver que presentó una recidiva de vasculitis ANCA positiva y fue tratado con rituximab con buena evolución.
Palabras clave:
trasplante renal, vasculitis, rituximab