title: Low-dose rituximab therapy for antibody-mediated rejection in a highly sensitized heart-transplant recipient.
abstract: Antibody-mediated rejection is the B-cell-mediated production of immunoglobulin G antibody against the transplanted heart. The currently available therapies for antibody-mediated rejection have had marginal success, and chronic manifestations of rejection can result in an increased risk of graft vasculopathy and perhaps require repeat transplantation. Rituximab, a monoclonal antibody directed against the CD20 receptor of B-lymphocytes and approved as therapy for lymphoma, can be used in heart-transplant patients for the management of antibody-mediated rejection. We present the case of a 52-year-old woman with high allosensitization (pre-transplantation panel reactive antibody level, 72%) who underwent successful orthotopic heart transplantation. Postoperatively, her acute antibody-mediated rejection with concomitant cellular rejection was successfully treated with low-dose rituximab. The patient died 5 months later because of multiple other medical problems. The present case suggests a role for low-dose rituximab as therapy for antibody-mediated rejection in heart-transplant patients.
authors.affiliation: Center for Heart Transplant and Assist Devices, Department of Pathology, Advocate Christ Medical Center, Oak Lawn, Illinois 60453, USA.
authors.forename: Ashim
authors.initials: A
authors.lastname: Aggarwal
authors.forename: Joseph
authors.initials: J
authors.lastname: Pyle
authors.forename: John
authors.initials: J
authors.lastname: Hamilton
authors.forename: Geetha
authors.initials: G
authors.lastname: Bhat
mesh_terms: D000888:Antibodies, Anti-Idiotypic / Q000276:immunology*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage*; D018951:Antigens, CD20; D004305:Dose-Response Relationship, Drug; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000276:immunology; D006085:Graft Survival / Q000276:immunology; D016027:Heart Transplantation / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology*; D007155:Immunologic Factors / Q000008:administration & dosage; D008875:Middle Aged; D000069283:Rituximab
chemical_list: D000888:Antibodies, Anti-Idiotypic; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D007074:Immunoglobulin G; D007155:Immunologic Factors; D000069283:Rituximab
keywords: Antibodies, monoclonal/therapeutic use; B-lymphocytes/immunology; HLA antigens/immunology; antigens, CD20/immunology; graft rejection/drug therapy; heart transplantation/pathology; immunity, humoral/physiology/therapy; immunoglobulins, intravenous/metabolism; plasmapheresis; rituximab; time factors