Date: Saturday, June 2, 2018
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall 4EF
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.
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 July 24, 2021.
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