Garrett HE, Duvall-Seaman D, Helsley B, Groshart K. Treatment of Vascular Rejection With Rituximab in Cardiac Transplantation.
J Heart Lung Transplant 2005;
24:1337-42. [PMID:
16143254 DOI:
10.1016/j.healun.2004.09.003]
[Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2004] [Revised: 08/30/2004] [Accepted: 09/04/2004] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND
Vascular rejection is the B-cell-mediated production of immunoglobulin G (IgG) antibody against the transplanted heart. The currently available treatments for vascular rejection have had limited success, and chronic manifestations of vascular rejection require re-transplantation. Rituximab is a monoclonal antibody directed against the CD20 receptor of B-lymphocytes, which is approved for treatment of lymphoma.
METHODS
Vascular rejection was defined as positive immunofluorescent endomyocardial biopsy staining for IgG and complement, 25% reduction in left ventricular ejection fraction (LVEF) from baseline, and absence of cellular rejection. Over the last 3 years, 8 patients with vascular rejection were treated with intravenous rituximab at a dose of 375 mg/m2 per week for 4 weeks.
RESULTS
All patients had normal LVEF post-transplant (average 58%), but developed left ventricular dysfunction (average decrease of 43%) associated with endomyocardial biopsy evidence of vascular rejection. Post-treatment, LVEF returned to baseline (average 53%) with complete resolution of immunofluorescent staining by endomyocardial biopsy. No patient suffered significant infection or drug-related complications.
CONCLUSIONS
Rituximab is beneficial for treatment of vascular rejection. Further study is indicated to verify the safety, efficacy and mechanism of action of rituximab therapy for vascular rejection.
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