title: A closer look at rituximab induction on HLA antibody rebound following HLA-incompatible kidney transplantation.
abstract: Rituximab has been used to increase the efficacy of desensitization protocols for human leukocyte antigen (HLA)-incompatible kidney transplantation; however, controlled comparisons have not been reported. Here we examined 256 post-transplant HLA antibody levels in 25 recipients desensitized with and 25 without rituximab induction, to determine the impact of B-cell depletion. We found significantly less HLA antibody rebound in the rituximab-treated patients (7% of donor-specific antibodies (DSAs) and 33% of non-DSAs) compared with a control cohort desensitized and transplanted without rituximab (32% DSAs and 55% non-DSAs). The magnitude of the increase was significantly larger among patients who did not receive rituximab. Interestingly, in rituximab-treated patients, of the 39 HLA antibodies that increased post transplant, 34 were specific for HLA mismatches present in previous allografts or pregnancies, implying limited efficacy in memory B-cell depletion. Compared with controls, rituximab-treated patients had a significantly greater mean reduction in DSA (-2505 vs. -292 mean fluorescence intensity), but a similar rate of DSA persistence (52% in rituximab treated-and 40% in non-treated recipients). Thus, rituximab induction in HLA-incompatible recipients reduced the incidence and magnitude of HLA antibody rebound, but did not affect DSA elimination, antibody-mediated rejection, or 5-year allograft survival when compared with recipients desensitized and transplanted without rituximab.
authors: Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors: Annette M
authors: AM
authors: Jackson
authors: Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors: Edward S
authors: ES
authors: Kraus
authors: Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
authors: Babak J
authors: BJ
authors: Orandi
authors: Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
authors: Dorry L
authors: DL
authors: Segev
authors: Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
authors: Robert A
authors: RA
authors: Montgomery
authors: Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors: Andrea A
authors: AA
authors: Zachary
mesh_terms: D000328:Adult; D001402:B-Lymphocytes / Q000276:immunology; D003888:Desensitization, Immunologic; D005260:Female; D006680:HLA Antigens; D006650:Histocompatibility Testing; D006801:Humans; D007156:Immunologic Memory; D007518:Isoantibodies / Q000096:biosynthesis*; D016030:Kidney Transplantation; D008213:Lymphocyte Activation; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D000069283:Rituximab / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies; D000069283:Rituximab