Treatment of humoral rejection with rituximab

Garrett, H. Edward; Groshart, Kenneth; Duvall-Seaman, Denise; Combs, Deena; Suggs, Rita

doi:10.1016/s0003-4975(02)03824-9

Cited by 65 publications

(37 citation statements)

References 3 publications

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“…32 There are multiple case reports of the successful use of rituximab as salvage therapy for refractory AMR after failure of combination therapy with cytolytic antibodies, corticosteroids, plasma exchange, and cyclophosphamide. 43,[158][159][160][161] Similarly, rituximab decreased PRA in a sensitized patient who failed to respond to combination therapy with IVIg, MMF, and plasma exchange. 162 Rituximab has been used successfully as combination therapy with plasma exchange and IVIg in other cardiac desensitization protocols.…”

Section: Monoclonal Antibodiesmentioning

confidence: 95%

Antibody-Mediated Rejection in Cardiac Transplantation: Emerging Knowledge in Diagnosis and Management

Colvin¹,

Cook²,

Chang³

et al. 2015

Circulation

287

251

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Section: Monoclonal Antibodiesmentioning

confidence: 95%

Antibody-Mediated Rejection in Cardiac Transplantation: Emerging Knowledge in Diagnosis and Management

Colvin¹,

Cook²,

Chang³

et al. 2015

Circulation

287

251

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“…26 Because all cells of B-cell lineage express CD20 antigen except pro-B cells and plasma cells, anti-CD20 antibody depletes activated B-cells. [27][28][29][30] It has been used for solid organ transplantations to prevent acute humoral rejection. Thus, preoperative administration of rituximab significantly lowered the postoperative isoagglutinin titers with favorable outcomes.…”

Section: Discussionmentioning

confidence: 99%

Adult Living Donor Liver Transplantation Across ABO-Incompatibility.

Lee

et al. 2014

Transplantation

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The objective of this study was to evaluate the results of adult ABO-incompatible living donor liver transplantation (LDLT).ABO-incompatible LDLT is an aggressive treatment that crosses the blood-typing barrier for saving lives from liver diseases. Although graft and patient survival have been improved recently by various treatments, the results of adult ABO-incompatible LDLT require further evaluation.Two regimens were designed based on isoagglutinin IgG and IgM titers and the time course of immunological reactions at this institute. When isoagglutinin IgG and IgM titers were 64, liver transplantation was directly performed and rituximab (375 mg/m 2 ) was administrated on postoperative day 1 (regimen I). When isoagglutinin titers were >64, rituximab (375 mg/m 2 ) was administered preoperatively with or without plasmapheresis and boosted on postoperative day 1 (regimen II). Immunosuppression was achieved by administration of mycophenolate mofetil, tacrolimus, and steroids.Forty-six adult ABO-incompatible and 340 ABO-compatible LDLTs were performed from 2006 to 2013. The Model for End-Stage Liver Disease scores for ABO-incompatible recipients ranged from 7 to 40, with a median of 14. The graft-to-recipient weight ratio ranged from 0.61% to 1.61% with a median of 0.91%. The 1-, 3-, and 5-year survival rates were 81.7%, 75.7%, and 71.0%, respectively, for ABO-incompatible LDLT recipients, compared to 81.0%, 75.2%, and 71.5% for ABO-C recipients (P ¼ 0.912). The biliary complication rate was higher in ABO-incompatible LDLT recipients than in the ABO-compatible recipients (50.0% vs 29.7%, P ¼ 0.009).In the rituximab era, the blood type barrier can be crossed to achieve adult ABO-incompatible LDLT with survival rates comparable to those of ABO-compatible LDLT, but with more biliary complications.

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“…[1][2][3][4][5] In previous case reports in which humoral rejection accompanying hemodynamic compromise was successfully treated, [6][7][8][9][10] the EF of the cardiac allografts was 20-40% at the time of diagnosis of humoral rejection. Cardiogenic shock so profound as to necessitate mechanical circulatory support with ECMO and IABP is rare, but many cases of early graft loss that were previously diagnosed as primary graft failure with unknown cause would have been the consequence of humoral rejection.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Cardiogenic Shock Caused by Humoral Cardiac Allograft Rejection

Saito

Matsumiya

Fukushima

et al. 2009

Circ J

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Circ J 2009; 73: 970 -973 ecause of progress in immunosuppressive therapy, heart transplantation is now the most effective treatment for end-stage heart failure. However, humoral rejection of the cardiac allograft is still a challenging problem associated with high incidence of graft loss and patient mortality. 1,2 We present a patient who developed severe cardiogenic shock from humoral rejection and who was successfully treated with a combination therapy consisting of plasmapheresis and pharmacological treatment including the anti-CD20 monoclonal antibody. Case ReportA 45-year-old gentleman with dilated cardiomyopathy who had been supported by a Novacor left ventricular assist device (WorldHeart Corp, Oakland, CA, USA) for 709 days underwent orthotopic heart transplantation. Although he had received a transfusion of packed red blood cells and platelets at the time of left ventricular assist device implantation, his pretransplant panel reactive antibody (PRA) was 0% and the prospective direct crossmatch was negative. The harvesting procedure was uneventful, and the heart was transplanted using the standard bicaval method. Total graft ischemic time was 204 min. Methylprednisolone (500 mg) was given prior to aortic declamping. Although the appearance of the heart surface was almost normal after reperfusion, biventricular dysfunction of the graft occurred. The heart function did not recover with catecholamine support, and mechanical circulatory support with intraaortic balloon pump (IABP) and extracorporeal membranous oxygenation (ECMO) were required to wean him off the cardiopulmonary bypass. Postoperative plasma level of troponin T was 1.17 ng/ml (normal range <0.10 ng/ml) and creatine kinase MB isoenzyme was 62.6 ng/ml (normal range <5.0 ng/ml). The immunosuppressive therapy in the immediate postoperative phase consisted of intravenous injection of 3 doses of 125 mg methylprednisolone followed by daily injection of prednisolone (20 mg/day), and antithymocyte globulin (700 mg/day for 5 days). The grafted heart's function gradually improved, and the ECMO and IABP were removed 3 and 4 days after transplantation, respectively. The patient was extubated on the 5th postoperative day. The left ventricular ejection fraction (LVEF) increased from 37% on the 2nd postoperative day to 60% on the day of extubation. Oral administration of cyclosporine, mycophenolate mofetil, and prednisolone was initiated on the 6th postoperative day. On the 8th postoperative day, the patient suddenly developed profound cardiogenic shock, which required the re-establishment of the IABP and ECMO support (Figure 1). Echocardiography revealed diffuse severe hypokinesis (LVEF <10%) and the thickening of the wall of both ventricles. Humoral rejection was highly suspected, so intravenous steroid pulse therapy and plasmapheresis were started immediately. Endomyocardial biopsy revealed no cellular rejection (International Society of Heart and Lung Transplantation grade 0), but there was severe interstitial edema (Figures 2A, B). Complement compon...

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Treatment of humoral rejection with rituximab

Cited by 65 publications

References 3 publications

Antibody-Mediated Rejection in Cardiac Transplantation: Emerging Knowledge in Diagnosis and Management

Antibody-Mediated Rejection in Cardiac Transplantation: Emerging Knowledge in Diagnosis and Management

Adult Living Donor Liver Transplantation Across ABO-Incompatibility.

Successful Treatment of Cardiogenic Shock Caused by Humoral Cardiac Allograft Rejection

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