Rituximab With Intravenous Immune Globulin in Sensitized Patients Awaiting Heart Transplant: Does It Work?

J. Patel, N. Reinsmoen, M. Kittleson, A. Velleca, D. Dilibero, F. Liou, D. Chang, A. Hage, L. Czer, F. Esmailian, J. Kobashigawa.

Cedars-Sinai Heart Institute, Los Angeles, CA.

Meeting: 2015 American Transplant Congress

Abstract number: C171

Keywords: Antibodies, Immunosuppression, Sensitization

Session Information

Session Name: Poster Session C: "Loss of Breath": VADs and Other Pre-Heart Transplant Matters

Session Type: Poster Session

Date: Monday, May 4, 2015

Session Time: 5:30pm-6:30pm

Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

Purpose: Highly sensitized heart transplant (HTx) recipients with donor specific antibodies (DSA) are at increased risk of rejection and death. Rituximab with Intravenous Immune Globulin (Rtx/IVIg) has been used for desensitization in patients (pts) awaiting heart transplant. We evaluated the efficacy of Rtx/IVIg in stable HTx recipients with DSA.

Methods: 21 pts mean 4.3±3.7 months post HTx with DSA underwent treatment with Rtx/IVIg (IVIg 1g/kg days 1,2, 30, 31; RTx 1g day7). Panel Reactive Antibodies (PRA) were determined prior to treatment and 2 weeks after treatment. High strength antibodies were determined by 1:8 dilution or C1q assay. Outcomes assessed included subsequent 6-month actuarial survival, freedom from treated acute cellular rejection (ACR), antibody mediated rejection (AMR), biopsy negative rejection (BNR), left ventricular dysfunction (LVD) (EF≤40%) and treated infection.

Results: 5/9 pts (55.6%) had decrease in Class I PRA, 6/15 pts (40.0%) decrease in Class II PRA. 0/3 pts with Class 1 1:8 PRA and only 2/9 pts (22.2%) with Class II 1:8 PRA responded to Rtx/IVIg. 1 pt with C1q Class I PRA responded and 5/10 pts (50%) with C1q Class II PRA. For all 21 pts, 6 month subsequent actuarial survival was 93.8%, freedom from treated ACR 100%, AMR 100%, BNR 90.5%, LV dysfunction 83.3% and treated infection 87.2%.

Conclusion: Rtx/IVIg appears to have a modest effect in reducing antibody burden after HTx particularly for those with high strength antibodies. Further studies are needed to determine the optimum candidates for this treatment.

To cite this abstract in AMA style:

Patel J, Reinsmoen N, Kittleson M, Velleca A, Dilibero D, Liou F, Chang D, Hage A, Czer L, Esmailian F, Kobashigawa J. Rituximab With Intravenous Immune Globulin in Sensitized Patients Awaiting Heart Transplant: Does It Work? [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/rituximab-with-intravenous-immune-globulin-in-sensitized-patients-awaiting-heart-transplant-does-it-work/. Accessed May 9, 2025.

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