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.
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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Authors: David J DiLillo; Robert Griffiths; Surya V Seshan; Cynthia M Magro; Phillip Ruiz; Thomas M Coffman; Thomas F Tedder Journal: J Immunol Date: 2011-01-19 Impact factor: 5.422
Authors: William Robert Morrow; Elizabeth A Frazier; William T Mahle; Terry O Harville; Sherry E Pye; Kenneth R Knecht; Emily L Howard; R Neal Smith; Robert L Saylors; Xiomara Garcia; Robert D B Jaquiss; E Steve Woodle Journal: Transplantation Date: 2012-02-15 Impact factor: 4.939
Authors: Catarina Costa; Ana Filipa Amador; João Calvão; Roberto Pinto; Pedro Rodrigues Pereira; José Pinheiro Torres; Sandra Amorim; Filipe Macedo Journal: Int J Heart Fail Date: 2022-03-28
Authors: Octavio E Pajaro; Dawn E Jaroszewski; Robert L Scott; Anantharam V Kalya; Henry D Tazelaar; Francisco A Arabia Journal: J Transplant Date: 2011-12-06