Antibody-mediated rejection in heart transplant recipients: potential efficacy of B-cell depletion and antibody removal.
We present four patients with late AMR following cardiac transplantation, which was associated with de novo post-transplant anti-HLA class II antibody production. All patients had negative anti-HLA class I and class II antibodies prior to transplantation (as assessed by sensitive Flow PRA bead assays) and had a negative retrospective T- and B-cell flow cytometric cross-match. Upon presentation with late graft rejection due to AMR, all patients were treated with rituximab and serial plasmapheresis with IVIg plus triple-drug immunosuppression therapy. Despite initial responses to therapy, relapses occurred in all of the patients and necessitated prolonged or multiple hospital admissions and second transplants in two cases. Post-transplant serum antibody monitoring did not prove to be predictive of treatment success or failure. Serum anti-HLA antibodies should be monitored after heart transplantation. We recommend an assessment of anti-HLA antibodies following a decline in immunosuppressant drug levels or in the presence of heart failure symptoms. Anti-HLA antibody detection should be performed using very sensitive techniques such as microparticle-based assays.
Bierl
Charlene
C
Department of Pathology, Heart Transplantation Program, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Miller
Barry
B
Prak
Eline Luning
EL
Gasiewski
Allison
A
Kearns
Jane
J
Tsai
Donald
D
Jessup
Mariell
M
Kamoun
Malek
M
D000328:Adult; D001402:B-Lymphocytes / Q000276:immunology*; D006084:Graft Rejection / Q000276:immunology*; D016027:Heart Transplantation / Q000276:immunology*; D006801:Humans; D007518:Isoantibodies / Q000097:blood* / Q000276:immunology / Q000302:isolation & purification; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D016896:Treatment Outcome
D007518:Isoantibodies