Tanriover B, Wright S E, Foster S V, Roush K S, Castillo-Lugo J A, Fa K, Levy F L, Mejia A
Dallas Nephrology Associates, Dallas, Texas 75208, USA.
Transplant Proc. 2008 Dec;40(10):3393-6. doi: 10.1016/j.transproceed.2008.08.131.
Antibody-mediated rejection (AMR) generally occurs in highly sensitized patients. A pilot study was performed on 7 consecutive patients with AMR to assess the efficacy of high-dose intravenous immunoglobulin (IVIG; 2 g/kg) + rituximab (RTX; 375 mg/m(2)) without plasmapheresis. After a 24-month follow-up, 1- and 2-year allograft survivals were 86% and 58%, respectively. C4d became negative in 1 patient posttreatment. Donor-specific antibody (DSA) titers decreased to less than 1:4 in 2 cases. There were 4 infectious complications and 1 case of aseptic meningitis followed by cranial nerve VI palsy. The average hospital charge for 1 administration of IVIG + RTX, including hospital stay and renal biopsy expenses, was approximately $49,000. A combination of IVIG + RTX in late AMR may be beneficial but is an expensive treatment approach for selected renal transplant patients.
抗体介导的排斥反应（AMR）通常发生在高度致敏的患者中。对7例连续的AMR患者进行了一项初步研究，以评估不进行血浆置换的大剂量静脉注射免疫球蛋白（IVIG；2 g/kg）+利妥昔单抗（RTX；375 mg/m²）的疗效。经过24个月的随访，1年和2年的移植肾存活率分别为86%和58%。1例患者治疗后C4d转阴。2例患者的供体特异性抗体（DSA）滴度降至低于1:4。有4例感染并发症，1例无菌性脑膜炎继发颅神经VI麻痹。包括住院和肾活检费用在内，一次IVIG + RTX治疗的平均住院费用约为49,000美元。IVIG + RTX联合应用于晚期AMR可能有益，但对于选定的肾移植患者来说是一种昂贵的治疗方法。
