The efficacy and safety of anti-interleukin-6 receptor monoclonal blockade in a renal transplant patient with Castleman disease

Early post-transplant outcome 11 Medical and Health Sciences 1103 Clinical Sciences

Masatoshi Matsunami, Yoshifumi Ubara, Keiichi Sumida, Yoichi Oshima, Masahiko Oguro, Kazuya Kinoshita, Kiho Tanaka, Yuki Nakamura, Keiichi Kinowaki, Kenichi Ohashi, Takeshi Fujii, Takuro Igawa, Yasuharu Sato, Yasuo Ishii

Research output: Contribution to journalArticle

Abstract

Background: Multicentric Castleman disease (MCD) is an uncommon lymphoproliferative disease characterized by systemic inflammatory reactions associated with the dysregulated production of interleukin-6 (IL-6). In patients with MCD, renal involvement is uncommon, with only one report published regarding kidney transplantation (KTx) to treat end-stage renal disease (ESRD) secondary to MCD. Recent clinical observations have shown that IL-6 production is implicated in allograft rejection, while IL-6 receptor blockade (with tocilizumab [TCZ]) reduces alloantibody generation and thereby improves graft survival; however, the efficacy and safety of TCZ in MCD patients undergoing KTx is still unknown. Case presentation: Herein, we describe the case of a 50-year-old man with MCD who received living-donor KTx for ESRD. Post-operative immunosuppression consisted of a triple-drug regimen (tacrolimus, mycophenolate mofetil and methylprednisolone) with TCZ that was administered intravenously every 2 weeks. At 17 months post-transplantation, the patient remains asymptomatic, and the allograft pathology has shown no evidence of rejection and no development of de novo donor-specific antibody (DSA). Conclusions: To our knowledge, this is the second reported case of an MCD patient with ESRD who underwent successful KTx. TCZ safely supported the patient during the perioperative period, and this drug may be useful for blocking the generation of donor-specific antibodies and reducing the risk of rejection episodes. KTx in combination with TCZ is thus considered a viable treatment option for ESRD due to MCD.

Original languageEnglish
Article number263
JournalBMC Nephrology
Volume19
Issue number1
DOIs
Publication statusPublished - Oct 11 2018

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Giant Lymph Node Hyperplasia
Interleukin-6 Receptors
Transplants
Kidney
Safety
Health
Chronic Kidney Failure
Allografts
Interleukin-6
Tissue Donors
Mycophenolic Acid
Isoantibodies
Perioperative Period
Antibodies
Living Donors
Methylprednisolone
Tacrolimus
Graft Survival
Multi-centric Castleman's Disease
Pharmaceutical Preparations

Keywords

  • Castleman disease
  • IgA nephropathy
  • IL-6
  • Kidney transplantation
  • Tocilizumab

ASJC Scopus subject areas

  • Nephrology

Cite this

The efficacy and safety of anti-interleukin-6 receptor monoclonal blockade in a renal transplant patient with Castleman disease : Early post-transplant outcome 11 Medical and Health Sciences 1103 Clinical Sciences. / Matsunami, Masatoshi; Ubara, Yoshifumi; Sumida, Keiichi; Oshima, Yoichi; Oguro, Masahiko; Kinoshita, Kazuya; Tanaka, Kiho; Nakamura, Yuki; Kinowaki, Keiichi; Ohashi, Kenichi; Fujii, Takeshi; Igawa, Takuro; Sato, Yasuharu; Ishii, Yasuo.

In: BMC Nephrology, Vol. 19, No. 1, 263, 11.10.2018.

Research output: Contribution to journalArticle

Matsunami, Masatoshi ; Ubara, Yoshifumi ; Sumida, Keiichi ; Oshima, Yoichi ; Oguro, Masahiko ; Kinoshita, Kazuya ; Tanaka, Kiho ; Nakamura, Yuki ; Kinowaki, Keiichi ; Ohashi, Kenichi ; Fujii, Takeshi ; Igawa, Takuro ; Sato, Yasuharu ; Ishii, Yasuo. / The efficacy and safety of anti-interleukin-6 receptor monoclonal blockade in a renal transplant patient with Castleman disease : Early post-transplant outcome 11 Medical and Health Sciences 1103 Clinical Sciences. In: BMC Nephrology. 2018 ; Vol. 19, No. 1.
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abstract = "Background: Multicentric Castleman disease (MCD) is an uncommon lymphoproliferative disease characterized by systemic inflammatory reactions associated with the dysregulated production of interleukin-6 (IL-6). In patients with MCD, renal involvement is uncommon, with only one report published regarding kidney transplantation (KTx) to treat end-stage renal disease (ESRD) secondary to MCD. Recent clinical observations have shown that IL-6 production is implicated in allograft rejection, while IL-6 receptor blockade (with tocilizumab [TCZ]) reduces alloantibody generation and thereby improves graft survival; however, the efficacy and safety of TCZ in MCD patients undergoing KTx is still unknown. Case presentation: Herein, we describe the case of a 50-year-old man with MCD who received living-donor KTx for ESRD. Post-operative immunosuppression consisted of a triple-drug regimen (tacrolimus, mycophenolate mofetil and methylprednisolone) with TCZ that was administered intravenously every 2 weeks. At 17 months post-transplantation, the patient remains asymptomatic, and the allograft pathology has shown no evidence of rejection and no development of de novo donor-specific antibody (DSA). Conclusions: To our knowledge, this is the second reported case of an MCD patient with ESRD who underwent successful KTx. TCZ safely supported the patient during the perioperative period, and this drug may be useful for blocking the generation of donor-specific antibodies and reducing the risk of rejection episodes. KTx in combination with TCZ is thus considered a viable treatment option for ESRD due to MCD.",
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T2 - Early post-transplant outcome 11 Medical and Health Sciences 1103 Clinical Sciences

AU - Matsunami, Masatoshi

AU - Ubara, Yoshifumi

AU - Sumida, Keiichi

AU - Oshima, Yoichi

AU - Oguro, Masahiko

AU - Kinoshita, Kazuya

AU - Tanaka, Kiho

AU - Nakamura, Yuki

AU - Kinowaki, Keiichi

AU - Ohashi, Kenichi

AU - Fujii, Takeshi

AU - Igawa, Takuro

AU - Sato, Yasuharu

AU - Ishii, Yasuo

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N2 - Background: Multicentric Castleman disease (MCD) is an uncommon lymphoproliferative disease characterized by systemic inflammatory reactions associated with the dysregulated production of interleukin-6 (IL-6). In patients with MCD, renal involvement is uncommon, with only one report published regarding kidney transplantation (KTx) to treat end-stage renal disease (ESRD) secondary to MCD. Recent clinical observations have shown that IL-6 production is implicated in allograft rejection, while IL-6 receptor blockade (with tocilizumab [TCZ]) reduces alloantibody generation and thereby improves graft survival; however, the efficacy and safety of TCZ in MCD patients undergoing KTx is still unknown. Case presentation: Herein, we describe the case of a 50-year-old man with MCD who received living-donor KTx for ESRD. Post-operative immunosuppression consisted of a triple-drug regimen (tacrolimus, mycophenolate mofetil and methylprednisolone) with TCZ that was administered intravenously every 2 weeks. At 17 months post-transplantation, the patient remains asymptomatic, and the allograft pathology has shown no evidence of rejection and no development of de novo donor-specific antibody (DSA). Conclusions: To our knowledge, this is the second reported case of an MCD patient with ESRD who underwent successful KTx. TCZ safely supported the patient during the perioperative period, and this drug may be useful for blocking the generation of donor-specific antibodies and reducing the risk of rejection episodes. KTx in combination with TCZ is thus considered a viable treatment option for ESRD due to MCD.

AB - Background: Multicentric Castleman disease (MCD) is an uncommon lymphoproliferative disease characterized by systemic inflammatory reactions associated with the dysregulated production of interleukin-6 (IL-6). In patients with MCD, renal involvement is uncommon, with only one report published regarding kidney transplantation (KTx) to treat end-stage renal disease (ESRD) secondary to MCD. Recent clinical observations have shown that IL-6 production is implicated in allograft rejection, while IL-6 receptor blockade (with tocilizumab [TCZ]) reduces alloantibody generation and thereby improves graft survival; however, the efficacy and safety of TCZ in MCD patients undergoing KTx is still unknown. Case presentation: Herein, we describe the case of a 50-year-old man with MCD who received living-donor KTx for ESRD. Post-operative immunosuppression consisted of a triple-drug regimen (tacrolimus, mycophenolate mofetil and methylprednisolone) with TCZ that was administered intravenously every 2 weeks. At 17 months post-transplantation, the patient remains asymptomatic, and the allograft pathology has shown no evidence of rejection and no development of de novo donor-specific antibody (DSA). Conclusions: To our knowledge, this is the second reported case of an MCD patient with ESRD who underwent successful KTx. TCZ safely supported the patient during the perioperative period, and this drug may be useful for blocking the generation of donor-specific antibodies and reducing the risk of rejection episodes. KTx in combination with TCZ is thus considered a viable treatment option for ESRD due to MCD.

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