title: Heart transplant with donor-specific antibody after immunoadsorption plus rituximab: a case report.
abstract: Different desensitization strategies are available for treating patients with preformed human leukocyte antigen (HLA) antibodies. A highly presensitized heart recipient received immunoadsorption and rituximab therapy. The patient, with end-stage heart failure, was positive only for antibodies of HLA class I (anti-A2, A10, B17), and Luminex platform (One Lambda kit) showed a panel-reactive antibody score of 64%. The patient's serum was tested repeatedly in both complement-dependent cytotoxicity and flow-cytometry crossmatches against cells from different potential organ donors. The results of these crossmatches were positive on flow cytometry when tested with HLA-A2, A10, and B17 but were still negative on cytotoxicity. The patient was treated with a desensitization regimen; this treatment immediately decreased antibody levels of 70% and the patient subsequently received a transplant with donor-specific HLA antibody (HLA-A2). After more than 2 years, graft function remains normal and the clinical status of the patient is stable.
authors.affiliation: Second University of Naples, Italy. marianna.resse@unina2.it
authors.forename: Marianna
authors.initials: M
authors.lastname: Resse
authors.forename: Ciro
authors.initials: C
authors.lastname: Maiello
authors.forename: Francesco
authors.initials: F
authors.lastname: Cacciatore
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Romano
authors.forename: Chiara
authors.initials: C
authors.lastname: Sabia
authors.forename: Antonietta
authors.initials: A
authors.lastname: Picascia
authors.forename: Fabio
authors.initials: F
authors.lastname: Ursomando
authors.forename: Claudio
authors.initials: C
authors.lastname: Napoli
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000276:immunology*; D003888:Desensitization, Immunologic / Q000379:methods; D005434:Flow Cytometry; D006085:Graft Survival; D015234:HLA-A Antigens / Q000276:immunology; D016027:Heart Transplantation / Q000276:immunology*; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage*; D007155:Immunologic Factors / Q000008:administration & dosage*; D007164:Immunosorbents / Q000627:therapeutic use*; D007518:Isoantibodies / Q000276:immunology*; D008297:Male; D000069283:Rituximab
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D015234:HLA-A Antigens; D007136:Immunoglobulins; D007155:Immunologic Factors; D007164:Immunosorbents; D007518:Isoantibodies; D000069283:Rituximab