Background: The incidence of graft rejection has been remarkably reduced by immunosuppressive medications such as rituximab and immunological techniques such as the solid phase assay. The suppression of graft rejection has yielded an excellent graft survival rate. In this study, we investigated the relationship between preoperative anti-HLA antibodies detected using the Luminex assay and the long-term graft survival rate in recipients who had or had not received rituximab treatment.
Materials and methods: In 2005, we began using rituximab as a component of the immunosuppressive protocol in immunological high-risk recipients, such as recipients receiving grafts across the blood or HLA barrier. The subjects in this study were categorized into four groups as follows: positivity for donor-specific antibodies (DSA+) and rituximab not administered (Rit-), n = 39; positivity for non-donor specific antibodies (NDSA+) and Rit-, n = 121; DSA+ and rituximab administered (Rit+), n=74; and NDSA+ and Rit+, n = 47. We then examined the influence of preoperative DSA and NDSA on the incidence of graft rejection and/or the survival rate of recipients who had or who had not received rituximab before transplantation.
Results: The 6-month acute rejection rates based on graft biopsies were 39%, 19%, 15%, and 0% for the DSA+/Rit-, NDSA+/Rit-, DSA+/Rit+, and NDSA+/Rit+ groups, respectively. The 6-month chronic antibody-mediated rejection rates were 50%, 22%, 18%, and 0%, respectively. The 6-month graft survival rate was significantly lower in the DSA+/Rit- group (84%) than in the other groups (95% for NDSA+/Rit-, 98% for DSA+/Rit+, and 91% for NDSA+/Rit+). The rate of appearance of de novo anti-HLA antibodies was higher in the groups that did not receive rituximab treatment than in the groups that were treated with rituximab.
Conclusions: Overall, the incidence of biopsy-proven graft rejection was significantly lower in the groups that were treated with rituximab than in the groups that were not treated with rituximab. The presence of DSA and the administration of the anti-CD20 antibody rituximab have strong impacts on not only short-term graft rejection, but also long-term graft rejection and its association with the graft survival time.
To cite this abstract in AMA style:Ishida H, Shimizu T, Furusawa M, Omoto K, Inui M, Nozaki T, Tanabe K. Influence of Preoperative Anti-HLA Antibodies on Short-Term and Long-Term Graft Survival in Recipients with or without Rituximab Treatment [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/influence-of-preoperative-anti-hla-antibodies-on-short-term-and-long-term-graft-survival-in-recipients-with-or-without-rituximab-treatment/. Accessed September 24, 2017.
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