Rituximab for antibody-mediated rejection after heart transplantation: A single-center retrospective study

Antibody-mediated rejection (AMR) is an important cause of graft dysfunction and mortality following heart transplantation. Evidence supporting the use of rituximab as adjunctive therapy remains limited. We conducted a retrospective single-center study of adult heart transplant recipients with biopsy-confirmed AMR treated with plasmapheresis and/or intravenous immunoglobulin between 2009 and 2018. Outcomes were compared between patients who received rituximab and those who did not. Rituximab-treated patients demonstrated higher numerical trends of AMR resolution (71% vs. 50%, p = 0.2), lower recurrence at 1 year (14% vs. 50%, p = 0.09), and higher one-year survival (93% vs. 75%, p = 0.5); however, none of these differences reached statistical significance. Improvements in left ventricular ejection fraction were observed more frequently in the rituximab group, while rates of graft dysfunction and readmission were similar between groups. These findings suggest a potential clinical signal for rituximab-containing regimens; however, the absence of statistically significant differences and the limitations of a small, retrospective cohort warrant cautious interpretation. Further prospective studies are needed to better define the role of rituximab in the management of AMR following heart transplantation.