Heart Transplant with Donor-Specific Antibody after Immunoadsorption plus Rituximab: A Case Report

Different desensitization strategies are available for treating patients with preformed human leukocyte antigen (HLA) antibodies. A highly presensitized heart recipient received immunoadsorption and rituximab therapy. The patient, with end-stage heart failure, was positive only for antibodies of HLA...

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Bibliographic Details
Published in:Progress in transplantation (Aliso Viejo, Calif.) Calif.), 2013-06, Vol.23 (2), p.128-131
Main Authors: Resse, Marianna, Maiello, Ciro, Cacciatore, Francesco, Romano, Gianpaolo, Sabia, Chiara, Picascia, Antonietta, Ursomando, Fabio, Napoli, Claudio
Format: Article
Language:English
Subjects:
Adult
Antibodies, Monoclonal, Murine-Derived - administration & dosage
Antibodies, Monoclonal, Murine-Derived - immunology
Desensitization, Immunologic - methods
Flow Cytometry
Graft Survival
Heart Transplantation - immunology
Histocompatibility Testing - methods
HLA-A Antigens - immunology
Humans
Immunoglobulins - administration & dosage
Immunologic Factors - administration & dosage
Immunosorbents - therapeutic use
Isoantibodies - immunology
Male
Nursing
Rituximab
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Summary:Different desensitization strategies are available for treating patients with preformed human leukocyte antigen (HLA) antibodies. A highly presensitized heart recipient received immunoadsorption and rituximab therapy. The patient, with end-stage heart failure, was positive only for antibodies of HLA class I (anti-A2, A10, B17), and Luminex platform (One Lambda kit) showed a panel-reactive antibody score of 64%. The patient's serum was tested repeatedly in both complement-dependent cytotoxicity and flow-cytometry crossmatches against cells from different potential organ donors. The results of these crossmatches were positive on flow cytometry when tested with HLA-A2, A10, and B17 but were still negative on cytotoxicity. The patient was treated with a desensitization regimen; this treatment immediately decreased antibody levels of 70% and the patient subsequently received a transplant with donor-specific HLA antibody (HLA-A2). After more than 2 years, graft function remains normal and the clinical status of the patient is stable.
ISSN:1526-9248
2164-6708
DOI:10.7182/pit2013454