title: The effectiveness of the combination of rituximab and high-dose immunoglobulin in the immunomodulation of sensitized kidney transplant candidates.
abstract: Kidney transplantation faces many challenges not the least of which is the presence of pre-formed HLA antibodies. At our institution, we have used a combination of methods to immunomodulate sensitized patients. Most recently, this has been attempted with a combination of immunoglobulin (IVIG) and rituximab (Rituxan; Genetech, CA, USA). A total of 31 patients were followed for up to one yr following treatment with IVIG (2 gm/kg on day 1 and day 30) and rituximab (1 g - day 15). Antibody levels were followed serially at designated time points via solid-phase single-antigen beads (SAB) method (One Lambda, Inc., Canoga Park, CA, USA). Concentration of antibodies was based on median fluorescence intensity (MFI). The majority of patients had both class I and class II antibodies (79%). Our results showed that this protocol appeared to be patient and antibody specific. The most pronounced MFI reduction in antibodies occurred within the 30- to 100-d period post-treatment. Calculated panel-reactive antibodies decreased but rebound tended to occur by 104 d after antibody MFI nadir. Because of this rebound, it can be inferred that the patients did not show a durable increase in their potential for transplantation. The search for a more effective method to immunomodulate patients continues.
authors.affiliation: Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA. tetaber@iupui.edu
authors.forename: Tim
authors.initials: T
authors.lastname: Taber
authors.forename: Muhammad Ahmad
authors.initials: MA
authors.lastname: Mujtaba
authors.forename: William
authors.initials: W
authors.lastname: Goggins
authors.forename: Nancy
authors.initials: N
authors.lastname: Higgins
authors.forename: Asif
authors.initials: A
authors.lastname: Sharfuddin
authors.forename: Muhammad Sohail
authors.initials: MS
authors.lastname: Yaqub
authors.forename: Dennis
authors.initials: D
authors.lastname: Mishler
authors.forename: Benita
authors.initials: B
authors.lastname: Book
authors.forename: Jeanne
authors.initials: J
authors.lastname: Chen
authors.forename: Andrew
authors.initials: A
authors.lastname: Lobashevsky
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D003888:Desensitization, Immunologic; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006680:HLA Antigens / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000276:immunology / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use; D056747:Immunomodulation; D007518:Isoantibodies / Q000097:blood / Q000276:immunology; D007676:Kidney Failure, Chronic / Q000276:immunology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D000069283:Rituximab; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D007518:Isoantibodies; D000069283:Rituximab
keywords: antibodies; immunomodulation; kidney; sensitized; transplant