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A closer look at rituximab induction on HLA antibody rebound following HLA-incompatible kidney transplantation.

Publication ,  Journal Article
Jackson, AM; Kraus, ES; Orandi, BJ; Segev, DL; Montgomery, RA; Zachary, AA
Published in: Kidney Int
February 2015

Rituximab has been used to increase the efficacy of desensitization protocols for human leukocyte antigen (HLA)-incompatible kidney transplantation; however, controlled comparisons have not been reported. Here we examined 256 post-transplant HLA antibody levels in 25 recipients desensitized with and 25 without rituximab induction, to determine the impact of B-cell depletion. We found significantly less HLA antibody rebound in the rituximab-treated patients (7% of donor-specific antibodies (DSAs) and 33% of non-DSAs) compared with a control cohort desensitized and transplanted without rituximab (32% DSAs and 55% non-DSAs). The magnitude of the increase was significantly larger among patients who did not receive rituximab. Interestingly, in rituximab-treated patients, of the 39 HLA antibodies that increased post transplant, 34 were specific for HLA mismatches present in previous allografts or pregnancies, implying limited efficacy in memory B-cell depletion. Compared with controls, rituximab-treated patients had a significantly greater mean reduction in DSA (-2505 vs. -292 mean fluorescence intensity), but a similar rate of DSA persistence (52% in rituximab treated-and 40% in non-treated recipients). Thus, rituximab induction in HLA-incompatible recipients reduced the incidence and magnitude of HLA antibody rebound, but did not affect DSA elimination, antibody-mediated rejection, or 5-year allograft survival when compared with recipients desensitized and transplanted without rituximab.

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Published In

Kidney Int

DOI

EISSN

1523-1755

Publication Date

February 2015

Volume

87

Issue

2

Start / End Page

409 / 416

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Time Factors
  • Rituximab
  • Middle Aged
  • Male
  • Lymphocyte Depletion
  • Lymphocyte Activation
  • Kidney Transplantation
  • Isoantibodies
  • Immunologic Memory
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Jackson, A. M., Kraus, E. S., Orandi, B. J., Segev, D. L., Montgomery, R. A., & Zachary, A. A. (2015). A closer look at rituximab induction on HLA antibody rebound following HLA-incompatible kidney transplantation. Kidney Int, 87(2), 409–416. https://doi.org/10.1038/ki.2014.261
Jackson, Annette M., Edward S. Kraus, Babak J. Orandi, Dorry L. Segev, Robert A. Montgomery, and Andrea A. Zachary. “A closer look at rituximab induction on HLA antibody rebound following HLA-incompatible kidney transplantation.Kidney Int 87, no. 2 (February 2015): 409–16. https://doi.org/10.1038/ki.2014.261.
Jackson AM, Kraus ES, Orandi BJ, Segev DL, Montgomery RA, Zachary AA. A closer look at rituximab induction on HLA antibody rebound following HLA-incompatible kidney transplantation. Kidney Int. 2015 Feb;87(2):409–16.
Jackson, Annette M., et al. “A closer look at rituximab induction on HLA antibody rebound following HLA-incompatible kidney transplantation.Kidney Int, vol. 87, no. 2, Feb. 2015, pp. 409–16. Pubmed, doi:10.1038/ki.2014.261.
Jackson AM, Kraus ES, Orandi BJ, Segev DL, Montgomery RA, Zachary AA. A closer look at rituximab induction on HLA antibody rebound following HLA-incompatible kidney transplantation. Kidney Int. 2015 Feb;87(2):409–416.
Journal cover image

Published In

Kidney Int

DOI

EISSN

1523-1755

Publication Date

February 2015

Volume

87

Issue

2

Start / End Page

409 / 416

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Time Factors
  • Rituximab
  • Middle Aged
  • Male
  • Lymphocyte Depletion
  • Lymphocyte Activation
  • Kidney Transplantation
  • Isoantibodies
  • Immunologic Memory