title: Successful management of antibody-mediated cardiac allograft rejection with combined immunoadsorption and anti-CD20 monoclonal antibody treatment: case report and literature review.
abstract: Chronic rejection is still the major limitation of long-term outcome of heart transplant recipients. Several recent studies demonstrated that a not negligible proportion of chronic allograft rejection episodes are not only mediated by T-cell response but also triggered by pre-transplant and de novo post-transplant donor-specific alloantibodies. This points at a fundamental role of humoral immune response mechanisms that contribute to early and late graft failure. This type of rejection is an unsolved problem solid organ transplantation because current immunosuppressive regimens are generally intended to interfere in T-cell signalling pathways. Various options for the removal of circulating alloantibodies and the prevention of alloantibody formation by B-cell depletion have been described. Nevertheless, effective standardized schemes for the treatment of antibody-mediated graft rejection have to be defined. We present a heart transplant recipient with sustained antibody-mediated graft rejection who was successfully managed with a combination treatment consisting of 3 cycles of immunoadsorption and a single-dose administration of the anti-CD20 monoclonal antibody rituximab.
authors: Department of Cardiac Surgery, University Hospital Grosshadern, Munich, Ludwig-Maximilians-University, Munich, Germany.
authors: Ingo
authors: I
authors: Kaczmarek
authors: Marcus-Andre
authors: MA
authors: Deutsch
authors: Sebastian
authors: S
authors: Sadoni
authors: Paolo
authors: P
authors: Brenner
authors: Daniel
authors: D
authors: Schmauss
authors: Sabine H
authors: SH
authors: Daebritz
authors: Max
authors: M
authors: Weiss
authors: Bruno M
authors: BM
authors: Meiser
authors: Bruno
authors: B
authors: Reichart
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000276:immunology; D003131:Combined Modality Therapy; D018450:Disease Progression; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology / Q000628:therapy*; D016027:Heart Transplantation / Q000009:adverse effects* / Q000276:immunology; D006801:Humans; D007163:Immunosorbent Techniques; D007167:Immunotherapy / Q000379:methods*; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D018570:Risk Assessment; D000069283:Rituximab; D012720:Severity of Illness Index; D014181:Transplantation Immunology; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D000069283:Rituximab