Table of Contents
ISRN Transplantation
Volume 2013, Article ID 819025, 8 pages
http://dx.doi.org/10.5402/2013/819025
Research Article

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

1Department of Pharmacy, Houston Methodist Hospital, 6565 Fannin Street, DB1-09, Houston, TX 77030, USA
2Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, SM1661, Houston, TX 77030, USA
3Department of Nephrology, Houston Methodist Hospital, 6550 Fannin Street, Suite 1001, Houston, TX 77030, USA
4Department of Nephrology, Baylor College of Medicine, 1709 Dryden Street, Houston, TX 77030, USA

Received 19 August 2013; Accepted 8 September 2013

Academic Editors: P. Ditonno and M. Veroux

Copyright © 2013 Samir J. Patel et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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 ( ) or without ( ) 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%; ). Viral infections occurred in 44% and 27% of RTX and no RTX patients, respectively ( ). This was largely driven by the frequency of BK viremia and noncytomegalovirus/non-BK viruses in RTX patients (27% versus 13% ( ) and 15% versus 2% ( ), resp.). Fungal infections also occurred more often in RTX patients (11% versus 3 %; ). Multivariate analysis revealed deceased donor recipient (odds ratio = 2.5; ) and rituximab exposure (odds ratio = 2.2; ) 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.