Combined Induction Therapy with Rabbit Antithymocyte Globulin and Rituximab in Highly Sensitized Renal Recipients

Compared to non-sensitized renal transplant recipients, patients with preformed alloantibodies are at greater risk of cellular and humoral rejection and premature graft failure. We explored the effects of adding B-cell depleting agent (rituximab) to standard rabbit anti-thymocyte globulin (rATG) ind...

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Bibliographic Details
Published in:Immunological investigations 2015-01, Vol.44 (4), p.373-384
Main Authors: Laftavi, Mark Reza, Pankewycz, Oleh, Feng, Lin, Said, Meriem, Patel, Sunil
Format: Article
Language:English
Subjects:
Adult
Animals
Antilymphocyte Serum - administration & dosage
Antilymphocyte Serum - therapeutic use
B-cell depleting
Drug Therapy, Combination
Female
Graft Rejection - diagnosis
Graft Rejection - immunology
Graft Rejection - mortality
Graft Rejection - prevention & control
Host vs Graft Reaction - drug effects
Host vs Graft Reaction - immunology
Humans
humoral rejection
Immunosuppressive Agents - administration & dosage
Immunosuppressive Agents - therapeutic use
Kaplan-Meier Estimate
Kidney Transplantation - adverse effects
Male
Middle Aged
Opportunistic Infections - etiology
Pilot Projects
PRA
Rabbits
Rituximab - administration & dosage
Rituximab - therapeutic use
thymoglobulin
Time Factors
Treatment Outcome
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Summary:Compared to non-sensitized renal transplant recipients, patients with preformed alloantibodies are at greater risk of cellular and humoral rejection and premature graft failure. We explored the effects of adding B-cell depleting agent (rituximab) to standard rabbit anti-thymocyte globulin (rATG) induction regimen for patients with panel reactive antibody levels >50%. Following induction therapy, 14 recipients were given two doses of rituximab (375 mg/m2) within the first month post-transplantation. Their long-term outcomes were compared to a historical control group of 23 recipients who received rATG alone. Graft survival at 5 years was superior with combination therapy compared to induction therapy alone (92.9 versus 48.3%, respectively, p = 0.02). While 30% of the rATG alone group experienced cellular rejection and 26% humoral rejection, none of rituximab plus rATG renal transplant recipients group had rejection. Thus, addition of rituximab to rATG provided superior outcomes to rATG alone. This combination induction therapy should be considered for a high-risk population.
ISSN:0882-0139
1532-4311
DOI:10.3109/08820139.2015.1014097