title: Anti-CD20 monoclonal antibody (rituximab) therapy for acute cardiac humoral rejection: a case report.
abstract: 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.
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, FL 32610, USA.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Aranda
authors.forename: Juan C
authors.initials: JC
authors.lastname: Scornik
authors.forename: Sigurd J
authors.initials: SJ
authors.lastname: Normann
authors.forename: Richard
authors.initials: R
authors.lastname: Lottenberg
authors.forename: Richard S
authors.initials: RS
authors.lastname: Schofield
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Pauly
authors.forename: Maureen
authors.initials: M
authors.lastname: Miles
authors.forename: James A
authors.initials: JA
authors.lastname: Hill
authors.forename: John W
authors.initials: JW
authors.lastname: Sleasman
authors.forename: Suzanne
authors.initials: S
authors.lastname: Skoda-Smith
mesh_terms: 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
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D006680:HLA Antigens; D000069283:Rituximab