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Highly Sensitized Patients: Miami Transplant Institute Experience.

Adela D Mattiazzi, Alexandra Centeno, Alexandra Amador

    Clinical Transplants
    |August 19, 2015
    PubMed
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    Adding Rituximab to desensitization treatments for highly sensitized transplant patients significantly improved patient and graft survival rates. This approach enhances outcomes in challenging transplant cases.

    Area of Science:

    • Transplantation immunology
    • Immunosuppression strategies
    • Organ transplantation

    Background:

    • Highly sensitized patients present significant challenges in transplantation.
    • Intravenous immunoglobulin (IVIG) is used for desensitization.
    • This study compares immunosuppression strategies based on immunologic risk stratification.

    Purpose of the Study:

    • To compare the efficacy of standard immunosuppression (IS) with Rituximab-based IS in highly sensitized transplant recipients undergoing desensitization.
    • To evaluate the impact of Rituximab on patient and graft survival.

    Main Methods:

    • Retrospective analysis of 42 kidney and 3 kidney-pancreas transplant recipients from 2008-2014.
    • Patients received either standard IS (Control group) or standard IS with Rituximab ± IVIG ± plasmapheresis (Rituximab group).

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  • Immunologic risk stratification included donor-specific antibodies (DSA) and flow cytometry crossmatch.

    • Main Results:

    • No significant differences in baseline characteristics, rejection rates, or graft function at 1 year between groups.
    • The Rituximab group had a shorter waiting time (4.1 vs. 6.4 years).
    • Cumulative patient and graft survival free of death or failure was significantly higher in the Rituximab group (87% vs. 60%).

    Conclusions:

    • Addition of Rituximab to IVIG desensitization and standard IS improves patient and graft survival in highly sensitized transplant recipients.
    • Rituximab-based immunosuppression is a valuable strategy for managing challenging transplant cases.