Anti-CD20 monoclonal antibody (rituximab) therapy for acute cardiac humoral rejection: a case report.
Humoral or antibody-mediated rejection in cardiac transplant recipients is mediated by donor-specific cytotoxic antibodies and is histologically defined by linear deposits of immunoglobulin and complement in the myocardial capillaries. Antibody-mediated rejection often is accompanied by hemodynamic compromise and is associated with reduced long-term graft survival. Standard immunosuppression, designed to target T cell immune function, is largely ineffective against this B cell-driven process. Current treatment options for humoral rejection are limited by a lack of specific anti-B cell therapies. We present the case of a 50-year-old woman with hemodynamically significant humoral rejection resistant to steroids, cyclophos-phamide, and plasmapheresis who responded to the addition of anti-CD20 monoclonal antibody therapy (rituximab). One year posttransplant, the patient is rejection-free, with normal left ventricular systolic function and coronary arteries.
Aranda
Juan M
JM
Department of Medicine, Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, FL 32610, USA.
Scornik
Juan C
JC
Normann
Sigurd J
SJ
Lottenberg
Richard
R
Schofield
Richard S
RS
Pauly
Daniel F
DF
Miles
Maureen
M
Hill
James A
JA
Sleasman
John W
JW
Skoda-Smith
Suzanne
S
D000208:Acute Disease; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D000917:Antibody Formation; D018951:Antigens, CD20 / Q000276:immunology; D001402:B-Lymphocytes / Q000276:immunology*; D009202:Cardiomyopathies / Q000601:surgery; D004351:Drug Resistance; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy*; D006680:HLA Antigens / Q000276:immunology; D016027:Heart Transplantation / Q000276:immunology* / Q000473:pathology; D006439:Hemodynamics; D006801:Humans; D008875:Middle Aged; D000069283:Rituximab; D013997:Time Factors; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D006680:HLA Antigens; D000069283:Rituximab