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

• 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
• ISSN: 0882-0139; 1532-4311
• DOI: 10.3109/08820139.2015.1014097

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.