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IVIG + Rituximab as Desensitization Agents to Reduce Donor Specific Antibodies and Improve Transplant Rates in Highly Hla Sensitized (HS) Awaiting Deceased Donor Kidney Transplantation.

R. Najjar, E. Huang, A. Vo, J. Cho, S. Louis, A. Hang, A. Peng, S. Jordan.

Medicine, Cedars-Sinai Medical Center, Los Angeles, CA

Meeting: 2017 American Transplant Congress

Abstract number: B74

Keywords: HLA antibodies

Session Information

Session Name: Poster Session B: Antibody Mediated Rejection in Kidney Transplant Recipients II

Session Type: Poster Session

Date: Sunday, April 30, 2017

Session Time: 6:00pm-7:00pm

 Presentation Time: 6:00pm-7:00pm

Location: Hall D1

Background: HS patients are at risk for development of donor specific antibodies (DSA) and the persistence of DSA is associated with poor graft outcomes. Rituximab, an anti-CD20, is used for B-cell depletion and reduction in DSA. Here we report outcomes of a prospective clinical trial evaluating the efficacy of rituximab in lowering DSA levels and reducing allograft injury post-transplant Methods: From 2013-2016, 39 HS patients with cPRA≥50% underwent desensitization (DES) Acceptable crossmatch criteria at transplant included: a negative CDC at 1:2 dilution; T& B-cell FCMX ≤ 225MCS Unacceptable antigens were defined as MFI>15,000. Patient and graft survival, freedom from ABMR, and DSA RIS score were analyzed. Patients with persistent DSA at 3M or 6M received one additional dose of rituximab 1 gm. Fifteen of 26 patients underwent protocol biopsy at 12M. Results: Twenty-six (67%) were transplanted after rituximab + IVIG DES. Nineteen patients (73%) were DSA+ @transplant. Of these, fifteen (58%) patients were also FCMX+. Baseline mean RIS score was 3.9 (±4.5) and decreased to 1.0 ((±2.5) by 12 months (Fig. 1, p=0.002). The actuarial incidence of ABMR was 16% at 2.5 years (Fig. 2a). Of those with ABMR on for-cause biopsies, Banff severity scores were relatively mild (Fig. 2b). On protocol biopsies at 12 months, there was a paucity of ABMR lesions, with only 2 patients found to have ABMR lesions. Both were mild with negative C4d and PTC+G and TG scores of 1 (Fig. 2b). Nine patients (35%) received an additional dose of rituximab at 3M or 6M post-transplant. Patient and graft survival was 100% and 96% @ 12M. There was one graft loss day 1 post Tx was deemed technical-related. Conclusions: Rituximab + IVIG is an effective and safe desensitization protocol. The addition of rituximab appeared to be efficacious in preventing ABMR and DSA rebound. Treatment with rituximab for persistent DSA at 3 or 6M post-transplant was associated with a significant reduction in DSA by 12M with low rates of ABMR, TG and graft loss.

CITATION INFORMATION: Najjar R, Huang E, Vo A, Cho J, Louis S, Hang A, Peng A, Jordan S. IVIG + Rituximab as Desensitization Agents to Reduce Donor Specific Antibodies and Improve Transplant Rates in Highly Hla Sensitized (HS) Awaiting Deceased Donor Kidney Transplantation. Am J Transplant. 2017;17 (suppl 3).

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To cite this abstract in AMA style:

Najjar R, Huang E, Vo A, Cho J, Louis S, Hang A, Peng A, Jordan S. IVIG + Rituximab as Desensitization Agents to Reduce Donor Specific Antibodies and Improve Transplant Rates in Highly Hla Sensitized (HS) Awaiting Deceased Donor Kidney Transplantation. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/ivig-rituximab-as-desensitization-agents-to-reduce-donor-specific-antibodies-and-improve-transplant-rates-in-highly-hla-sensitized-hs-awaiting-deceased-donor-kidney-transplantation/. Accessed June 3, 2025.

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