American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists · 2026
Obinutuzumab for B-cell depletion prior to kidney transplant in a highly sensitized patient with anaphylactic reaction to rituximab.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
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Lizondo Thais, Carro Iria, Bastida Carla, Monge-Escartín Inés, Charry Paola, Lozano Miquel, Gelis Sonia, Revuelta Ignacio, Soy Dolors
Аннотация
PURPOSE: The purpose of this case report is to present a successful approach for the depletion of B cells and plasma cells in a highly sensitized patient prior to kidney transplantation using obinutuzumab, as well as to evaluate the potential of obinutuzumab in desensitization as an alternative to rituximab in cases of rituximab-induced anaphylaxis.
SUMMARY: Kidney transplantation stands as the gold standard treatment for end-stage kidney disease, offering improved quality of life and longevity. Living donor kidney transplantation is preferred over deceased donor transplantation due to its superior outcomes, but immunological barriers, such as human leukocyte antigen sensitization and ABO blood type incompatibility, remain significant challenges. This study explores desensitization strategies and emerging therapies to overcome these barriers to achieve successful ABO-incompatible kidney transplantation. We present the case of a 32-year-old woman with end-stage kidney disease secondary to systemic lupus erythematosus who was awaiting a living unrelated donor ABO-incompatible kidney transplantation. Due to elevated isoagglutinin titers, the patient underwent a desensitization treatment with rituximab, to which she had a severe anaphylactic reaction. Consequently, desensitization was completed with obinutuzumab (off-label use). The patient successfully underwent kidney transplantation with adequate isoagglutinin levels and without rejection.
CONCLUSION: Desensitization strategies, including B-cell depletion with obinutuzumab, played a crucial role in achieving successful kidney transplantation in a highly sensitized patient. This case underscores the importance of personalized approaches and ongoing research aimed at overcoming immunological barriers to kidney transplantation.
SUMMARY: Kidney transplantation stands as the gold standard treatment for end-stage kidney disease, offering improved quality of life and longevity. Living donor kidney transplantation is preferred over deceased donor transplantation due to its superior outcomes, but immunological barriers, such as human leukocyte antigen sensitization and ABO blood type incompatibility, remain significant challenges. This study explores desensitization strategies and emerging therapies to overcome these barriers to achieve successful ABO-incompatible kidney transplantation. We present the case of a 32-year-old woman with end-stage kidney disease secondary to systemic lupus erythematosus who was awaiting a living unrelated donor ABO-incompatible kidney transplantation. Due to elevated isoagglutinin titers, the patient underwent a desensitization treatment with rituximab, to which she had a severe anaphylactic reaction. Consequently, desensitization was completed with obinutuzumab (off-label use). The patient successfully underwent kidney transplantation with adequate isoagglutinin levels and without rejection.
CONCLUSION: Desensitization strategies, including B-cell depletion with obinutuzumab, played a crucial role in achieving successful kidney transplantation in a highly sensitized patient. This case underscores the importance of personalized approaches and ongoing research aimed at overcoming immunological barriers to kidney transplantation.