Pre-Emptive Rituximab and Intravenous Immunoglobulin (IVIg) Fail to Prevent Rejection in Kidney Transplant Recipients (KTx) with Donor Specific Antibodies (DSA)
Columbia University, New York, NY.
Meeting: 2018 American Transplant Congress
Abstract number: A153
Keywords: Alloantibodies, IVIG, Rejection
Session Information
Session Name: Poster Session A: Kidney Immunosuppression: Desensitization
Session Type: Poster Session
Date: Saturday, June 2, 2018
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall 4EF
Introduction:
IVIg and Rituximab have been used successfully to improve transplantation rates in sensitized patients. DSA detected by Flow crossmatch (FXM+) or Luminex® at time of transplantation carries an increased risk of both acute cellular (ACR) and antibody mediated rejection(AMR), and worse graft outcomes. In hopes of reducing early rejection rates, select DSA+ KTx also received pre-emptive treatment with Ritux+IVIg at the time of transplant. Many of these patients also had protocol biopsies for 5 years.
Methods/Results: Between 1/1/2010 to 12/31/2016, we performed 184 KTx (113 DDTRx) with detectable DSA by Luminex. 73 were FXM+, 110 were FXM-, and in one case FXM not performed(excluded from analysis). Immunosuppression was tacrolimus + mycophenolate, and induction was Campath in 62, Thymoglobulin in 87, and basiliximab in 34 (1 did not complete induction due to technical graft thrombosis). At the time of transplant, 65 DSA+ pts also received Rituximab 375 mg/m2 and IVIg 2 gm/kg q2 months for 4 cycles, 5 received rituximab alone, and 11 received IVIg alone. KTx patients with DSA rejected frequently (62% overall, 49% ACR, 37% AMR). FXM+ pts had more AMR then FXM- pts (58.9% vs 21.8%, p <0.001) but similar rates of ACR (46% vs 54%, p=NS). Among DSA+/FXM- pts (n=110), recipients of Ritux/IVIg were more likely to reject[mdash]HR 2.13 (p=0.0071), AMR- HR=1.5 (p-0.362), ACR- 1.85 (p-0.045). The increased rate of rejection was partly driven by detection of ACR on protocol biopsies (For DSA+/FXM-: 22/32 ACR if protocol bx vs 29/78 if no protocol bx, p<0.003). Ritux/IVIg had no impact on graft or patient survival. There were also no differences in serum creatinine, rates of CMV, EBV, or BK viremia.
Conclusion:
Our experience confirms an increased ACR and AMR in pts with DSA. While there is likely selection bias in the decision to use pre-emptive Ritux/IVIg, we were unable to find any evidence to suggest that this combination reduced rejection rates or improved allograft survival.
CITATION INFORMATION: Crew J., Vasilescu R., Campenot E., Mohan S., Patel S. Pre-Emptive Rituximab and Intravenous Immunoglobulin (IVIg) Fail to Prevent Rejection in Kidney Transplant Recipients (KTx) with Donor Specific Antibodies (DSA) Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Crew J, Vasilescu R, Campenot E, Mohan S, Patel S. Pre-Emptive Rituximab and Intravenous Immunoglobulin (IVIg) Fail to Prevent Rejection in Kidney Transplant Recipients (KTx) with Donor Specific Antibodies (DSA) [abstract]. https://atcmeetingabstracts.com/abstract/pre-emptive-rituximab-and-intravenous-immunoglobulin-ivig-fail-to-prevent-rejection-in-kidney-transplant-recipients-ktx-with-donor-specific-antibodies-dsa/. Accessed May 9, 2025.« Back to 2018 American Transplant Congress