High-Dose Intravenous Immunoglobulin and Rituximab Treatment for Antibody-Mediated Rejection After Kidney Transplantation: A Cost Analysis

One-year Results of the Effects of Rituximab on Acute Antibody-Mediated Rejection in Renal Transplantation

“…Only case series were previously reported, and a systematic review of acute AMR treatment published in October 2012 showed insufficient data to guide treatment. 12,[16][17][18][19][20][21][22][23][24][25][26][27][28][29]32 We showed that 1-year graft survival for AMR treated with IVIg, PE, and CS with or without rituximab was excellent, and we could not demonstrate a supplementary efficacy of rituximab by graft survival or our primary endpoint. An additional beneficial effect of PE and rituximab on graft survival was reported in a group of 12 patients receiving IVIg, PE, and rituximab (92%) as compared with a historical group of 12 patients receiving only IVIg (50%) 29 ; however, the respective impact of PE and rituximab could not be assessed, especially because graft survival was observed in about 80% of patients receiving IVIg and PE treatment in the literature.…”

“…15 All other reports have been single case reports or case series. [16][17][18][19][20][21][22][23][24][25][26][27][28][29] The findings suggest that rituximab may have some beneficial effects in the treatment of acute AMR along with standard treatment of the condition.…”

Rational clinical trial design for antibody mediated renal allograft injury

“…Overall, a recent meta-analysis suggested that rituximab is a clinically effective treatment for AMR. (82) Treatment with rituximab is currently an expensive approach, and some recommend use only in AMR patients with low initial DSA titers (<1:128 dilution), creatinine of <3 mg/dL at the time of rejection, and mild tubular atrophy/interstitial fibrosis on renal biopsy (83). Reported adverse effects of rituximab therapy include lung toxicity, greater need for IVIg supplementation, infectious and infusion complications including fatal Jacob-Kreutzflet encephalitis (79, 84).…”

Antibody-mediated rejection in kidney transplantation: an update

“…Three patients had significant viral infections but recovered fully. Several other recent reports support the utility of rituximab in treating acute AMR [50][51][52][53]. Some of the studies are limited by incomplete criteria for AMR diagnosis (especially older studies before the advent of DSA and C4d) and inconsistent patient variables.…”