New monoclonal antibodies study results reported from M. Matignon et al
2008 JAN 16 -- According to recent research published in the journal Transplantation Proceedings, "There is no optimal desensitization protocol for cadaveric renal transplant recipients who display high levels of donor-specific alloantibodies as defined by a positive T- or B-cell cytotoxic crossmatch. We used anti-CD20 monoclonal antibodies (Rituximab) to try to prevent antibody-mediated rejection in three crossmatch-positive renal transplants recipients (standard and sensitized techniques)." "The three patients received a first, second, or third cadaveric donor renal transplant. Patient one had an historical positive T- and B-cell cytotoxicity crossmatch: negative T- and B-cell cytotoxicity crossmatch at the day of transplantation. The panel reactive antibody (PRA) level was 100%. Patients 2 and 3 showed positive B-cell cytotoxicity crossmatches: historical and on the day of transplantation; PRA levels were 50% and 71%, respectively. All recipients were treated pretransplant with rituximab (375 mg/m(2)) and 4 days of intravenous immunoglobulin (0.5 g/kg body weight) per day posttransplant plus 5 days of thymoglobulin. Maintenance immunosuppression consisted of tacrolimus, mycophenolate mofetil, and prednisone. Antibody-mediated rejection occured in all patients at day 6, day 10, or 8 months after renal transplantation. For patient 1, the rejection was not reversible and the graft was lost at day 15. Patient 2 had poor renal function with an MDRD estimate of glomerular filtration rate at 36 mL/min/1.73 m(2) at IS months posttransplantation, and the graft of patient 3 was lost at 9 months posttransplantation due to resistant antibody-mediated rejection with thrombotic microangiopathy. In these three cases of crossmatch-positive patients, rituximab failed to prevent antibody-mediated rejection," wrote M. Matignon and colleagues. The researchers concluded: "Others studies will be needed to determine the place of rituximab in these patients." Matignon and colleagues published their study in Transplantation Proceedings (Failure of anti-CD20 monoclonal antibody therapy to prevent antibody-mediated rejection in three crossmatch-positive renal transplant recipients. Transplantation Proceedings, 2007;39(8):2565-2567). For additional information, contact P. Grimbert, Henri Mondor Hospital, Nephrology & Transplantation Unit, Dept. of Nephrology & Transplantation, Creteil, France. The publisher's contact information for the journal Transplantation Proceedings is: Elsevier Science Inc., 360 Park Avenue South, New York, NY 10010-1710, USA. Keywords: France, Creteil, Biotechnology, Kidney Transplant, Medical Device, Monoclonal Antibodies, Monoclonal Antibody, Nephrology, Organ Transplant, Renal Allograft, Renal Transplant, Therapy, Transplantation, Treatment. This article was prepared by Immunotherapy Weekly editors from staff and other reports. Copyright 2008, Immunotherapy Weekly via NewsRx.com.
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