高剂量静脉注射免疫球蛋白和利妥昔单抗治疗肾移植后抗体介导的排斥反应：一项成本分析。
High-dose intravenous immunoglobulin and rituximab treatment for antibody-mediated rejection after kidney transplantation: a cost analysis.
作者信息
Tanriover B, Wright S E, Foster S V, Roush K S, Castillo-Lugo J A, Fa K, Levy F L, Mejia A
机构信息
Dallas Nephrology Associates, Dallas, Texas 75208, USA.
出版信息
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。
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