Sequential Dosing of Rituximab and IVIg for Desensitization of Highly-HLA Sensitized (HS) Patients Awaiting HLAi Kidney Transplantation
Kidney Transplant, Cedars Sinai Medical Ctr, Los Angeles, CA
Meeting: 2019 American Transplant Congress
Abstract number: B183
Keywords: B cells, HLA antibodies, IVIG, Kidney transplantation
Session Information
Session Name: Poster Session B: Kidney Immunosuppression: Desensitization
Session Type: Poster Session
Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Recent observations suggest that the use of IVIg + rituximab has a critical role in modifying allo-reactive B-cells prior to HLAi kidney transplantation, thus preventing or reducing DSA rebound post-transplant. We hypothesized that providing two doses of rituximab may be more beneficial than placing doses in close proximity to IVIg which may enhance clearance by inhibiting recycling through the FcRn pathway. Thus, we report on revision of our protocol to use two doses of rituximab given sequentially followed by two doses of IVIg.
*Methods: From 12/16 to 9/18, 64 HS patients (cPRA 80-100%) underwent desensitization with rituximab 375mg/m2 x 2 doses (week 0 & 2) followed by IVIg 2gm/kg (maximum 140g) x 2 doses (week 3 & 6). Rates of transplantation, time to transplantation after completion of desensitization, freedom from ABMR, and patient & graft survival were assessed.
*Results: Of 64 patients undergoing desensitization, 26 (41%) patients received HLAi DD kidney transplants (3 with cPRA <90%, 13 with cPRA 90-98% and 10 with cPRA 99-100%). Important observations from this study include: 1). Mean wait time on dialysis was 77 ± 56M prior to initiation of desensitization. Mean time to transplant after desensitization was 4.1 ± 3.4M. Eleven (42%) of transplanted patients received kidney transplants with FCMX+ & DSA+ at time of transplant. DSA rebound occurred in 5 patients w. FCMX+/DSA+, but only 2 patients (7.5%) experienced ABMR post-transplant {Fig 1}. Death-censored patient and graft survival were 96% and 100% at 18M, respectively.
*Conclusions: The use of two consecutive doses of rituximab followed by IVIg allowed successful transplantation in 41% of HS patients in this observation period. cPRAs did not change in this protocol, but 55% showed reductions in DSA at transplant. Sequential administration of two doses of rituximab likely avoids rapid degradation of circulating rituximab due to IVIg administration in close proximity which blocks FcRn recycling mechanism.
To cite this abstract in AMA style:
Vo AA, Huang E, Williamsons S, Myers C, Peng A, Najjar R, Sethi S, Lim K, Ammerman N, Jordan SC. Sequential Dosing of Rituximab and IVIg for Desensitization of Highly-HLA Sensitized (HS) Patients Awaiting HLAi Kidney Transplantation [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/sequential-dosing-of-rituximab-and-ivig-for-desensitization-of-highly-hla-sensitized-hs-patients-awaiting-hlai-kidney-transplantation/. Accessed May 8, 2025.« Back to 2019 American Transplant Congress