Original Article
Rituximab and Intravenous Immune Globulin for Desensitization during Renal Transplantation
N Engl J Med 2008; 359:242-251July 17, 2008
- Abstract
Background
Few options for transplantation currently exist for patients highly sensitized to HLA. This exploratory, open-label, phase 1–2, single-center study examined whether intravenous immune globulin plus rituximab could reduce anti-HLA antibody levels and improve transplantation rates.
Methods
Between September 2005 and May 2007, a total of 20 highly sensitized patients (with a mean [±SD] T-cell panel-reactive antibody level, determined by use of the complement-dependent cytotoxicity assay, of 77±19% or with donor-specific antibodies) were enrolled and received treatment with intravenous immune globulin and rituximab. We recorded rates of transplantation, panel-reactive antibody levels, cross-matching results at the time of transplantation, survival of patients and grafts, acute rejection episodes, serum creatinine values, adverse events and serious adverse events, and immunologic factors.
Results
The mean panel-reactive antibody level was 44±30% after the second infusion of intravenous immune globulin (P<0.001 for the comparison with the pretreatment level). At study entry, the mean time on dialysis among recipients of a transplant from a deceased donor was 144±89 months (range, 60 to 324). However, the time to transplantation after desensitization was 5±6 months (range, 2 to 18). Sixteen of the 20 patients (80%) received a transplant. At 12 months, the mean serum creatinine level was 1.5±1.1 mg per deciliter (133±97 μmol per liter), and the mean survival rates of patients and grafts were 100% and 94%, respectively. There were no infusion-related adverse events or serious adverse events during the study. Long-term monitoring for infectious complications and neurologic problems revealed no unanticipated events.
Conclusions
These findings suggest that the combination of intravenous immune globulin and rituximab may prove effective as a desensitization regimen for patients awaiting a transplant from either a living donor or a deceased donor. Larger and longer trials are needed to evaluate the clinical efficacy and safety of this approach. (ClinicalTrials.gov number, NCT00642655.)
Media in This Article
Figure 1
Panel-Reactive Antibody Levels in the 20 Study Patients.Figure 2
Mean Channel Shifts from T-Cell Flow-Cytometric Cross-Matching of the 16 Study Patients with Donors.Article Activity
- Article
Renal transplantation is considered the treatment of choice for patients with end-stage renal disease, since it offers improved survival and quality-of-life benefits as compared with dialysis and is considerably less costly to payers.1-3 Currently, there are more than 74,275 patients with end-stage renal disease in the United States on the deceased-donor waiting list, and more than 30,000 new registrants are added each year. Despite this, there are fewer than 18,000 total kidney transplantations in the United States each year.4
The waiting times for kidney transplants continue to increase, owing to the limited supply. This is especially true for patients for whom matching is difficult (those considered to be highly HLA sensitized).4-7 Alloantibodies (anti-HLA antibodies) arise through previous transplants, blood transfusions, and pregnancy. Currently, approximately 30% of the patients on the waiting list have evidence of sensitization, and only 6.5% of highly sensitized patients (those with a panel-reactive antibody level above 80%) receive a transplant each year.4 Over the past several years, two regimens have evolved to help improve transplantation rates in highly sensitized patients. These are the high-dose intravenous immune globulin protocol and the plasmapheresis plus low-dose intravenous immune globulin protocol.8-12
Our group previously reported results of the use of the high-dose intravenous immune globulin protocol and examined its efficacy in a randomized, multicenter, placebo-controlled trial in highly HLA-sensitized patients conducted by the National Institutes of Health (NIH) (the NIH IG02 study).9 From the NIH IG02 study, we observed that intravenous immune globulin significantly lowered anti-HLA antibody levels (P=0.04) and improved rates of transplantation (primarily from deceased donors) as compared with placebo (35% vs. 17%, P=0.02). The projected mean waiting time to transplantation was 4.8 years for patients treated with intravenous immune globulin as compared with 10.3 years for those who received placebo (P=0.03). The 3-year allograft survival rate was 80% in the intravenous immune globulin group as compared with 70% in the placebo group (P not significant).9
A protocol for high-dose intravenous immune globulin that was similar to the protocol in the NIH IG02 trial was used at our center from 2000 until 200510 and appears to be effective for some patients. However, the protocol required patients to undergo a 4-month period of treatment (with monthly doses of 2 g per kilogram of body weight, for a total of four doses) and was not always effective. For these reasons, we explored other potential approaches that might be as effective, might reduce the time to desensitization, and might be less costly.
Among such treatments, we considered rituximab, a chimeric anti-CD20 monoclonal antibody that reduces B-cell and antibody levels. The role of rituximab as a desensitizing agent has not been clearly defined. This monoclonal antibody has had demonstrated efficacy in the treatment of autoimmune diseases and is reported to be effective in the treatment of antibody-mediated transplant rejection.13-16 Other groups have reported that rituximab has synergistic effects with intravenous immune globulin in autoimmune skin diseases.14
Our exploratory, open-label, phase 1–2, single-center study examined whether intravenous immune globulin plus rituximab was safe and effective in reducing the levels of anti-HLA antibodies and improving transplantation rates.
Methods
Study Design
The data for this investigator-initiated study were gathered, analyzed, and verified by the investigators; the manuscript, in all stages, was written by the authors. The representatives of the sponsor, Genentech, reviewed the manuscript before submission but made no substantive changes.
The study used an open-label design to examine whether human polyclonal intravenous immune globulin (10% formulation) given twice (2 g per kilogram of body weight on day 0 and day 30), plus rituximab given twice (1 g on day 7 and day 22), could reduce the rate of, or eliminate, a positive cross-match in highly HLA-sensitized patients awaiting transplantation at Cedars–Sinai Medical Center. The rituximab dose was based on data from published reports concerning rituximab use in patients with rheumatoid arthritis or autoimmune diseases.17-19
Donor-specific flow-cytometric cross-matching was performed at study entry, after treatment, and before transplantation. Safety data and limited data on efficacy (changes in panel-reactive antibody levels, cross-matching result, and rate of transplantation) were obtained on day 0 (the day of infusion), at weeks 1, 2, 4, and 6, and at months 3, 6, and 12. Safety data were also obtained during and immediately after infusion, when patients were monitored for side effects such as fever, headache, and shortness of breath. In addition, patients were monitored over the course of the study for viral infections and side effects related to the central nervous system. The patients were followed to determine the proportion with reductions in anti-HLA antibody levels who subsequently obtained and retained a viable and functioning kidney allograft. All patients were evaluated on an intention-to-treat basis. To ensure the safety of all patients, the accrual rate was limited to no more than five patients per month in the first 3 months.
Written informed consent was obtained from all patients. The study was performed in accordance with the protocols approved by the institutional review board of Cedars–Sinai Medical Center. Between September 2005 and May 2007, a total of 20 patients were enrolled. All patients were highly HLA-sensitized (mean [±SD] prestudy panel-reactive antibody level, 77±19%) or had donor-specific antibodies and were on the waiting list for a kidney transplant from a deceased donor or a living donor.
Rituximab was provided by Genentech. All doses of intravenous immune globulin were infused during a 4-hour hemodialysis session, as described previously.9 Rituximab infusions were administered in an outpatient infusion center over a 6-hour period, with frequent monitoring of vital signs. To reduce the frequency of infusion-related side effects, 30 to 60 minutes before scheduled infusions of intravenous immune globulin or rituximab, all patients were given intravenous methylprednisolone (40 mg), oral acetaminophen (650 mg), and oral diphenhydramine (50 mg).
Donor-Specific Cross-Matching, Anti-HLA Antibodies, and Transplantation
Donor-specific flow-cytometric cross-matching, complement-dependent cytotoxicity cross-matching, and the T-cell complement-dependent cytotoxicity panel-reactive antibody assay were performed as described previously.9,20 Three-color donor-specific cross-matching was performed according to the method of Bray et al.20 with the use of a flow cytometer (FACScan, Becton Dickinson). T cells and B cells were stained with phycoerythrin-conjugated mouse monoclonal antibody specific for human CD3 and CD19, respectively. The presence of bound antibody was determined by means of fluorescein isothiocyanate–conjugated antihuman IgG antibodies (Jackson ImmunoResearch Laboratories).
After completion of the protocol, patients were eligible to receive a kidney transplant from a living or deceased donor. When donors became available, cross-matching was performed on serum samples collected after treatment, and the results were deemed acceptable or unacceptable. An acceptable cross-match was defined as a T-cell complement-dependent cytotoxicity cross-match that was negative at a 1:2 dilution of the serum in saline, a T-cell donor-specific flow-cytometric cross-match that was negative or remained positive (with a mean flow-channel shift [the number of binding fluorescent units above the background number] of <250 [normal background number, <50]), or both.
Post-Transplantation Induction Protocol and Maintenance Immunosuppressive Therapy
Patients who received a transplant were given a single dose of alemtuzumab (30 mg subcutaneously) as induction therapy immediately after transplantation.21 Subsequent maintenance immunosuppressive therapy consisted of prednisone (2 mg per kilogram, with a rapid tapering to 5 mg per day by 2 weeks after transplantation), mycophenolate mofetil (500 mg twice daily), and tacrolimus administered to maintain a target blood level of 7 to 9 ng per milliliter for the first 3 months, 6 to 8 ng per milliliter for months 3 to 6, and 5 to 7 ng per milliliter after 6 months.
Treatment of Allograft-Rejection Episodes
Biopsy-proven, cell-mediated rejection episodes were treated with a pulse of methylprednisolone (10 mg per kilogram per day for 3 days), as well as rabbit antithymocyte globulin (1.5 mg per kilogram per day, with the total dose not exceeding 6 mg per kilogram). Patients who had episodes of antibody-mediated rejection that were C4d+ (Banff antibody-mediated rejection grade I or II)22,23 were initially given a pulse of methylprednisolone (10 mg per kilogram per day for 3 days), intravenous immune globulin (2 g per kilogram once), and rituximab (375 mg per square meter of body-surface area). Patients with severe antibody-mediated rejection (Banff grade III) or thrombotic microangiopathy underwent plasmapheresis (three to five sessions) followed by repeat administration of intravenous immune globulin (2 g per kilogram) and rituximab (375 mg per square meter).23
CD19+ and CD20+ Cells and Human Antichimeric Antibodies
CD19+ cells and CD20+ cells were detected by means of flow cytometry involving a direct single-staining method. Heparinized blood samples (100 μl each) were mixed with phycoerythrin-conjugated mouse anti-CD19 antibodies or phycoerythrin-conjugated mouse anti-CD20 antibodies (5 μl) and were incubated at room temperature for 30 minutes in a dark room. Fluorescence-activated cell-sorting lysing solution (2 ml, BD Biosciences) was added, followed by incubation for 10 minutes. After the addition of 2 ml of buffer (0.5% bovine serum albumin in phosphate-buffered saline with 0.1% sodium azide) and centrifugation, 400 μl of 1% paraformaldehyde was added, and within 24 hours the mixture was processed in a flow cytometer (Dako). A total of 100,000 cells were detected. Data analysis was performed with the use of Summit software (Dako). Human antichimeric antibodies were monitored, by means of an enzyme-linked immunosorbent assay, at selected time points for all patients.24
Infection-Prophylaxis Protocols
All patients who received a transplant, regardless of their cytomegalovirus status, received intravenous ganciclovir while in the hospital and valganciclovir for 6 months as outpatients, with dose adjustments for renal function. Fungal prophylaxis was accomplished with the use of nystatin (10 ml, four times daily for 1 month). Prophylaxis against Pneumocystis carinii and other bacteria was accomplished with the use of trimethoprim (80 mg) and sulfamethoxazole (400 mg) daily for 4 months.
Monitoring for Viral Infections after Transplantation
For all highly sensitized patients who received a kidney transplant, polymerase-chain-reaction assays for cytomegalovirus, Epstein–Barr virus, parvovirus B-19, and polyomavirus BK were performed on whole-blood specimens monthly for 6 months after transplantation. The methods used for monitoring viral replication have been described previously.25
Monitoring for Adverse Events and Serious Adverse Events
There are concerns regarding the use of rituximab, because it has been reported to induce reactivation of polyomavirus JC virus, resulting in progressive multifocal leukoencephalopathy in patients with systemic lupus erythematosus.26 As part of our monitoring program, patients were questioned, after each infusion and at all follow-up visits, about the development of motor deficits, memory loss, and other neurologic symptoms. Monitoring for adverse events and serious adverse events was continued after transplantation.
Statistical Analysis
Paired t-tests were used to analyze patient and graft survival rates, mean serum creatinine level, transplant status (single vs. multiple), type of acute rejection episode (C4d– vs. C4d+), the interaction of transplant status and cross-match result, and panel-reactive antibody status. Reported P values are two-sided, and P values of less than 0.05 were considered to indicate statistical significance.
Results
Characteristics of the Patients
The 20 highly sensitized patients, all of whom were older than 18 years of age, underwent desensitization with intravenous immune globulin and rituximab, each over a 4-week period. Of the 20 patients, 16 (80%) subsequently underwent successful transplantation (with 6 receiving a kidney from a deceased donor and 10 receiving a kidney from a living donor). Of the remaining four patients, three were still awaiting a transplant from a deceased donor at the time of this writing, but all have panel-reactive antibody levels that were greater than 50%.
The mean follow-up time was 22.1±6.0 months, and 100% of patients had at least 12 months of follow-up (Table 1Table 1
Baseline Characteristics of the 20 Study Patients.). All 16 patients who received a transplant were deemed to have a high immunologic risk (63% had received one or more previous transplants and 69% had evidence of a positive cross-match on flow cytometry at the time of transplantation). Ten of the 16 patients receiving transplants (62%), 6 from a living donor and 4 from a deceased donor, had panel-reactive antibody levels above 50%. Survival of patients and grafts, acute rejection episodes, infectious complications, and renal function were monitored. Table 1 and Table 2Table 2
Immunologic Findings and Infectious Complications of the 16 Patients Who Received a Transplant. summarize the baseline characteristics, immunologic profiles, and infectious complications of the patients.Patients who received a transplant from a deceased donor were on the waiting list for 144±89 months (range, 60 to 324) before receiving intravenous immune globulin and rituximab for desensitization but had to wait only an additional 5±6 months (range, 2 to 18) after this treatment for a transplant. These patients did not receive additional United Network for Organ Sharing points toward transplantation for participation in this study.
Immunologic Factors
All patients had reduced numbers of CD19+ cells after rituximab infusion (mean percentage of total lymphocytes that were B cells, 6.12±0.18% before treatment vs. 0.90±0.02% after treatment; P<0.001). Human antichimeric antibodies did not develop in any patient during the study. Panel-reactive antibody levels were significantly reduced after treatment with intravenous immune globulin and rituximab (77±19% before the first infusion of intravenous immune globulin, vs. 44±30% after the second infusion; P<0.001) (Figure 1Figure 1
Panel-Reactive Antibody Levels in the 20 Study Patients.). T-cell flow-cytometric cross-matching was performed on samples obtained before treatment, after treatment, and immediately before transplantation (Figure 2Figure 2Mean Channel Shifts from T-Cell Flow-Cytometric Cross-Matching of the 16 Study Patients with Donors.). The mean channel shifts were 212±95 before treatment, 245±104 after treatment, and 149±97 before transplantation (P=0.02 for comparison of the channel shifts before treatment and before transplantation).Survival Rates of Patients and Grafts
The 12-month patient and allograft survival rates among the 16 patients receiving a transplant were 100% and 94%, respectively. All 16 of these patients have had at least a year of follow-up. The single allograft that was lost was from a living donor in a recipient with stable renal function 1 year after transplantation who had a severe rejection episode after her immunosuppressive therapy was reduced at an outside hospital. From an immunologic standpoint, 62% of the patients who underwent desensitization and transplantation had panel-reactive antibody levels that were greater than 50%, 63% had had one or more previous transplants, and 69% of patients had a positive cross-match on flow cytometry at the time of transplantation.
Acute Rejection Episodes
Acute rejection episodes occurred in 50% of patients who received a transplant, and 31% of these episodes were C4d+ antibody–mediated rejections. Most rejection episodes occurred within the first month after transplantation and were reversible with treatment. However, two patients had late antibody-mediated rejection episodes (more than 6 months after transplantation) that were related to subtherapeutic immunosuppressive drug levels. Donor-specific antibody levels were monitored after transplantation in four patients with antibody-mediated rejection. Three of the four had increases in donor-specific antibody levels in association with the antibody-mediated rejection. New donor-specific antibodies were not detected, and antibody levels decreased after treatment.
Renal Function
Serum creatinine values for individual patients and mean serum creatinine values are shown in Figure 3Figure 3
Serum Creatinine Values in the 16 Patients Who Received a Kidney Transplant after Desensitization.. Mean serum creatinine values 1 month, 3 months, 6 months, and 12 months after transplantation were 1.3±0.9, 1.2±0.4, 1.3±0.6, and 1.5±1.1 mg per deciliter (115±80, 106±35, 115±53, and 133±97 μmol per liter), respectively.Adverse Events, Serious Adverse Events, and Infections
No patients to date have had neurologic symptoms suggestive of progressive multifocal leukoencephalopathy. No viral infections were seen after transplantation in patients who were treated with intravenous immune globulin and rituximab for desensitization. Urinary tract infections developed in 7 of the 16 patients who received a transplant, who were then treated with oral antibiotics (Table 2). No patients required hospitalization, and the rate of urinary tract infection was not greater than that among transplant recipients who are not highly sensitized. No other important infectious complications were noted. No infusion-related side effects were noted in study patients, probably owing to the medication regimen used before infusion and the long infusion times. Our previous work9 showed that the rates of adverse events and serious adverse events did not differ significantly among highly sensitized patients treated with intravenous immune globulin during hemodialysis as compared with those who received placebo.
Discussion
Among patients with high levels of preformed anti-HLA antibodies (i.e., high panel-reactive antibody levels), who are thus highly sensitized, renal-transplantation rates are low because of the additional immunologic barrier. When transplantation is performed in such patients, the incidence of antibody-mediated rejection is high, with unacceptable rates of graft loss.4-7 Thus, the highly sensitized patient is destined to remain on the waiting list for extended periods of time while undergoing dialysis, an additional risk factor for death and graft loss.4,9 Thus, early transplantation would result in considerable cost savings, reduced morbidity and mortality, and improved quality of life.
Intravenous immune globulin products are known to have powerful immunomodulatory effects.27 There are compelling clinical and laboratory data that suggest that intravenous immune globulin therapy administered to highly sensitized patients may reduce allosensitization and acute rejection episodes and result in better long-term outcomes for recipients of cardiac or renal allografts.9,11,12,28-31 However, in spite of the efficacy of intravenous immune globulin, its use in these patients is not completely effective. In fact, patients with high anti-HLA antibody titers, detected with the use of complement-dependent cytotoxicity cross-matching and flow-cytometric cross-matching, have only a partial response or none at all. Other investigators have shown that plasmapheresis and administration of intravenous immune globulin may also improve the success of transplantation in this group. However, the rejection rates are high, and this approach is effective only in patients awaiting transplants from living donors.11,12
The use of rituximab, which is directed against the CD20 antigen, would seem to be a logical strategy, since reduction or elimination of B cells that express CD20 and make anti-HLA antibodies should have a beneficial effect. However, there are problems with this concept. First, anti-CD20 activity has no effect on plasma cells, which are the primary source of acute antibody production. Second, rituximab has no immediate effect on circulating antibody levels. These problems might limit the benefit of rituximab if it were used as the sole treatment.13 However, it appears that the use of rituximab in combination with other treatments (e.g., plasmapheresis, intravenous immune globulin, or both) might constitute an improved approach for the management of allosensitization. Vieira et al. performed a small phase 1 study using rituximab alone as a desensitization agent; there were no significant reductions in the panel-reactive antibody levels or antibody specificity in most of the patients.13 Other investigators have demonstrated that rituximab treatment for antibody-mediated rejection results in the reduction or elimination of donor-specific antibodies.15,16
The use of rituximab may also lead to prolonged and substantial interference with both flow-cytometric cross-matching and complement-dependent cytotoxicity assays for B cells, complicating its use in desensitization protocols and analysis of B-cell cross-match results for patients awaiting a transplant from a deceased donor.
We believe that the data presented here, reflecting the use of a combination of intravenous immune globulin and rituximab, are encouraging and may support further analysis of this approach. There are potential advantages for the use of intravenous immune globulin and rituximab as compared with currently accepted approaches to desensitization. For example, protocols for plasmapheresis and low-dose intravenous immune globulin are suitable only for recipients of transplants from living donors. High-dose intravenous immune globulin has been shown to be effective as a desensitization agent for patients receiving transplants from either living or deceased donors,9 but it requires monthly infusions over a 4-month period for optimal results.
Although transplantation was not a primary end point in the NIH IG02 study,9 35% of the patients underwent transplantation during a 2-year observation period, as compared with 17% in the placebo group. In our smaller, nonrandomized study, transplantation was accomplished in 80% of the patients, and treatment time was reduced from 16 weeks to 5 weeks. In addition, our patients who received a transplant from a deceased donor had been on a waiting list for a mean of 12 years (range, 5 to 27) but received transplants within 5 to 6 months after treatment with intravenous immune globulin plus rituximab. These observations might have important implications for highly sensitized patients awaiting transplants from deceased donors. Larger and longer trials are needed to assess the safety of this approach.
Supported by Genentech and Biogen Idec, which also provided the drugs used in the study.
Dr. Reinsmoen reports receiving lecture fees from Cylex; and Dr. Jordan, receiving consulting fees and grant support from Talecris and Bristol-Myers Squibb and lecture fees from Genentech and owning a patent entitled “Use of IVIG in Desensitization,” issued on January 9, 2001 (6171585B1, with co-owner Dr. Dolly Tyan; application filed in 1994). No other potential conflict of interest relevant to this article was reported.
Source Information
From the Comprehensive Transplant Center, Transplant Immunology Laboratory, and HLA Laboratory, Cedars–Sinai Medical Center, Los Angeles.
Address reprint requests to Dr. Vo at the Comprehensive Transplant Center, Cedars–Sinai Medical Center, 8635 W. 3rd St., Suite 590W, Los Angeles, CA 90048, or at ashley.vo@cshs.org.
- References
References
1
Evans RW ,Manninen DL ,Garrison LP Jr , et al. The quality of life of patients with end-stage renal disease. N Engl J Med 1985;312:553-559
Full Text | Web of Science | Medline2
Port FK ,Wolfe RA ,Mauger EA ,Berling DP ,Jiang K . Comparison of survival probabilities for dialysis patients vs cadaveric renal transplant recipients. JAMA 1993;270:1339-1343
CrossRef | Web of Science | Medline3
Russell JD ,Beecroft ML ,Ludwin D ,Churchill DN . The quality of life in renal transplantation -- a prospective study. Transplantation 1992;54:656-660
CrossRef | Web of Science | Medline4
Organ Procurement and Transplantation Network. Scientific registry of transplant recipients. (Accessed June 23, 2008, at http://www.optn.org/data/.)
5
Gebel HM ,Bray RA ,Nickerson P . Pre-transplant assessment of donor-reactive, HLA-specific antibodies in renal transplantation: contraindication vs. risk. Am J Transplant 2003;3:1488-1500
CrossRef | Web of Science | Medline6
Kerman RH ,Gebel HM ,Bray RA , et al. HLA antibody and donor reactivity define patients at risk for rejection or graft loss. Am J Transplant 2002;2:Suppl:258-2587
Cho YW, Cecka J. Crossmatch tests: an analysis of UNOS data from 1991 to 2000. In: Terasaki P, ed. Clinical transplants. Los Angeles: UCLA Immunogenetics Center, 2001:237-46.
8
Jordan SC ,Vo A ,Bunnapradist S , et al. Intravenous immune globulin treatment inhibits crossmatch positivity and allows for successful transplantation of incompatible organs in living-donor and cadaver recipients. Transplantation 2003;76:631-636
CrossRef | Web of Science | Medline9
Jordan SC ,Tyan D ,Stablein D , et al. Evaluation of intravenous immunoglobulin as an agent to lower allosensitization and improve transplantation in highly sensitized adult patients with end-stage renal disease: report of the NIH IG02 trial. J Am Soc Nephrol 2004;15:3256-3262
CrossRef | Web of Science | Medline10
Jordan SC ,Vo A ,Peng A ,Toyoda M ,Tyan D . Intravenous gammaglobulin (IVIG): a novel approach to improve transplant rates and outcomes in highly HLA-sensitized patients. Am J Transplant 2006;6:459-466
CrossRef | Web of Science | Medline11
Gloor JM ,DeGoey SR ,Pineda AA , et al. Overcoming a positive crossmatch in living-donor kidney transplantation. Am J Transplant 2003;3:1017-1023
CrossRef | Web of Science | Medline12
Montgomery RA, Cooper M, Kraus E, et al. Renal transplantation at the Johns Hopkins Comprehensive Transplant Center. In: Cecka JM, Terasaki PI, eds. Clinical transplants. Los Angeles: UCLA Immunogenetics Center, 2003:199-213.
13
Vieira CA ,Agarwal A ,Book BK , et al. Rituximab for reduction of anti-HLA antibodies in patients awaiting renal transplantation: safety, pharmacodynamics, and pharmacokinetics. Transplantation 2004;77:542-548
CrossRef | Web of Science | Medline14
Ahmed AR ,Spigelman Z ,Cavacini LA ,Posner MR . Treatment of pemphigus vulgaris with rituximab and intravenous immune globulin. N Engl J Med 2006;355:1772-1779
Full Text | Web of Science | Medline15
Faguer S ,Kamar N ,Guilebeaud-Frugier C , et al. Rituximab therapy for acute humoral rejection after kidney transplantation. Transplantation 2007;83:1277-1280
CrossRef | Web of Science | Medline16
Salama AD ,Pusey CD . Drug insight: rituximab in renal disease in transplantation. Nat Clin Pract Nephrol 2006;2:221-230
CrossRef | Web of Science | Medline17
Edwards JC ,Szczepanski L ,Szechinski J , et al. Efficacy of B-cell targeted therapy with rituximab in rheumatoid arthritis. N Engl J Med 2004;350:2572-2581
Full Text | Web of Science | Medline18
Edwards JC ,Cambridge G . B-cell targeting in rheumatoid arthritis and other autoimmune diseases. Nat Rev Immunol 2006;6:394-403
CrossRef | Web of Science | Medline19
Schuna AA . Rituximab for treatment of rheumatoid arthritis. Pharmacotherapy 2007;27:1702-1710
CrossRef | Web of Science | Medline20
Bray RA ,Lebeck KL ,Gebel HM . The flow cytometric crossmatch: dual color analysis of T cell and B cell reactivities. Transplantation 1989;48:834-840
CrossRef | Web of Science | Medline21
Vo AA ,Weschler EA ,Wang J , et al. Analysis of subcutaneous (SQ) alemtuzumab induction therapy in highly sensitized patients desensitized with IVIG and rituximab. Am J Transplant 2008;8:144-149
Web of Science | Medline22
Solez K ,Colvin RB ,Racusen LC , et al. Banff '05 meeting report: differential diagnosis of chronic allograft injury and elimination of chronic allograft nephropathy (`CAN'). Am J Transplant 2007;7:518-526
CrossRef | Web of Science | Medline23
Jordan SC ,Vo AA ,Tyan D ,Nast CC ,Toyoda M . Current approaches to treatment of antibody-mediated rejection. Pediatr Transplant 2005;9:408-415
CrossRef | Web of Science | Medline24
Reff ME ,Carner K ,Chambers KS , et al. Depletion of B cells in vivo by a chimeric mouse human monoclonal antibody to CD20. Blood 1994;83:435-445
Web of Science | Medline25
Toyoda M ,Puliyanda DP ,Amet N , et al. Co-infection of polyomavirus-BK and cytomegalovirus in renal transplant recipients. Transplantation 2005;80:198-205
CrossRef | Web of Science | Medline26
Center for Drug Evaluation and Research. FDA public health advisory: life-threatening brain infection in patients with systemic lupus erythematosus after Rituxan (rituximab) treatment. 2006. (Accessed June 23, 2008, at http://www.fda.gov/cder/drug/advisory/rituximab.htm.)
27
Kazatchkine MD ,Kaveri SV . Immunomodulation of autoimmune and inflammatory diseases with intravenous immune globulin. N Engl J Med 2001;345:747-755
Full Text | Web of Science | Medline28
Schweitzer EJ ,Wilson JS ,Fernandez-Vina M , et al. A high panel-reactive antibody rescue protocol for cross-match-positive live donor kidney transplants. Transplantation 2000;70:1531-1536
CrossRef | Web of Science | Medline29
Glotz D ,Antoine C ,Julia P , et al. Intravenous immunoglobulins and transplantation for patients with anti-HLA antibodies. Transpl Int 2004;17:1-8
CrossRef | Web of Science | Medline30
Tyan DB ,Li VA ,Czer L ,Trento A ,Jordan SC . Intravenous immunoglobulin suppression of HLA alloantibody in highly sensitized transplant candidates and transplantation with a histoincompatible organ. Transplantation 1994;57:553-562
CrossRef | Web of Science | Medline31
Jordan SC ,Pescovitz MD . Presensitization: the problem and its management. Clin J Am Soc Nephrol 2006;1:421-432
CrossRef | Web of Science | Medline
- Citing Articles (145)
Citing Articles
1
Taku Aoki, Yasuhiko Sugawara, Michiro Takahashi, Yoshikuni Kawaguchi, Junichi Kaneko, Noriyo Yamashiki, Sumihito Tamura, Kiyoshi Hasegawa, Kouki Takahashi, Norihiro Kokudo. (2012) Living donor liver transplantation using sensitized lymphocytotoxic crossmatch positive graft. Journal of Gastroenterology
CrossRef2
E. I. Anyaegbu, P. S. Almond, T. Milligan, W. R. Allen, S. Gharaybeh, S. I. Al-Akash. (2012) Intravenous immunoglobulin therapy in the treatment of BK viremia and nephropathy in pediatric renal transplant recipients. Pediatric Transplantation 16:1, E19-E24
CrossRef3
Vinayak Ramanath, Ravi Nistala, Kunal Chaudhary. (2012) Update on the role of rituximab in kidney diseases and transplant. Expert Opinion on Biological Therapy 12:2, 223-233
CrossRef4
Martina Guthoff, Barbara Schmid-Horch, Katja C. Weisel, Hans-Ulrich Häring, Alfred Königsrainer, Nils Heyne. (2012) Proteasome inhibition by bortezomib: Effect on hla-antibody levels and specificity in sensitized patients awaiting renal allograft transplantation. Transplant Immunology
CrossRef5
Scott L. Sanoff, Rasheed A. Balogun, Peter L. Lobo. (2012) The Role of Therapeutic Apheresis in High Immunologic Risk Renal Transplantation: A Review of Current Trends. Seminars in Dialysisno-no
CrossRef6
H. Billing, B. Tönshoff. (2012) Akute antikörpervermittelte Rejektion nach Nierentransplantation. Der Nephrologe
CrossRef7
Andrew S Levey, Josef Coresh. (2012) Chronic kidney disease. The Lancet 379:9811, 165-180
CrossRef8
S.C. Jordan, N. Reinsmoen, C.-H. Lai, K. Cao, J. Kahwaji, A. Peng, R. Villicana, A. Vo. (2012) Desensitizing the Broadly Human Leukocyte Antigen–Sensitized Patient Awaiting Deceased Donor Kidney Transplantation. Transplantation Proceedings 44:1, 60-61
CrossRef9
Gregor Bartel, Elisabeth Schwaiger, Georg A. Böhmig. (2011) Prevention and treatment of alloantibody-mediated kidney transplant rejection. Transplant International 24:12, 1142-1155
CrossRef10
Jignesh Patel, Matthew Everly, David Chang, Michelle Kittleson, Elaine Reed, Jon Kobashigawa. (2011) Reduction of alloantibodies via proteosome inhibition in cardiac transplantation. The Journal of Heart and Lung Transplantation 30:12, 1320-1326
CrossRef11
Georg A. Böhmig, Markus Wahrmann, Gregor Bartel. (2011) Transplantation of the broadly sensitized patient. Current Opinion in Organ Transplantation 16:6, 588-593
CrossRef12
Lars P Kihm, Martin Zeier, Christian Morath. (2011) Emerging drugs for the treatment of transplant rejection. Expert Opinion on Emerging Drugs 16:4, 683-695
CrossRef13
M. D. Stegall, T. Diwan, S. Raghavaiah, L. D. Cornell, J. Burns, P. G. Dean, F. G. Cosio, M. J. Gandhi, W. Kremers, J. M. Gloor. (2011) Terminal Complement Inhibition Decreases Antibody-Mediated Rejection in Sensitized Renal Transplant Recipients. American Journal of Transplantation 11:11, 2405-2413
CrossRef14
Maryvonne Hourmant, Claire Garandeau. (2011) L’évolution de la transplantation rénale ces 20 dernières années. La Presse Médicale 40:11, 1074-1080
CrossRef15
Hideaki Uchiyama, Yohei Mano, Akinobu Taketomi, Yuji Soejima, Tomoharu Yoshizumi, Toru Ikegami, Ken Shirabe, Yoshihiko Maehara. (2011) Kinetics of Anti-Blood Type Isoagglutinin Titers and B Lymphocytes in ABO-Incompatible Living Donor Liver Transplantation With Rituximab and Plasma Exchange. Transplantation 92:10, 1134-1139
CrossRef16
E. Canet, J. Dantal, G. Blancho, M. Hourmant, S. Coupel. (2011) Tuberculosis following kidney transplantation: clinical features and outcome. A French multicentre experience in the last 20 years. Nephrology Dialysis Transplantation 26:11, 3773-3778
CrossRef17
M. Toyoda, S. Ge, E. Suviolahti, P. Pichurin, B. Shin, A. Pao, A. Vo, N. Deer, A. Aguiluz, A. Karasyov, S.C. Jordan. (2011) IFNγ production by NK cells from HLA-sensitized patients after in vitro exposure to allo-antigens. Transplant Immunology
CrossRef18
(2011) Desensitization of HLA-Incompatible Kidney Recipients. New England Journal of Medicine 365:17, 1643-1645
Full Text19
J. Michael Cecka. (2011) Transplantation: Desensitization and transplantation for sensitized patients?. Nature Reviews Nephrology 7:12, 682-683
CrossRef20
Arvind Bhimaraj, David O. Taylor. (2011) How to deal with presensitized candidates for heart transplantation?. Current Opinion in Organ Transplantation 16:5, 529-535
CrossRef21
Petra M Meiners, Arjan Vissink, Cees GM Kallenberg, Frans GM Kroese, Hendrika Bootsma. (2011) Treatment of primary Sjögren's syndrome with anti-CD20 therapy (rituximab). A feasible approach or just a starting point?. Expert Opinion on Biological Therapy 11:10, 1381-1394
CrossRef22
M. Haas, J. Mirocha. (2011) Early Ultrastructural Changes in Renal Allografts: Correlation With Antibody-Mediated Rejection and Transplant Glomerulopathy. American Journal of Transplantation 11:10, 2123-2131
CrossRef23
Matthew H. Levine, Peter L. Abt. (2011) Treatment options and strategies for antibody mediated rejection after renal transplantation. Seminars in Immunology
CrossRef24
J. Waiser, K. Budde, M. Schutz, L. Liefeldt, B. Rudolph, C. Schonemann, H.-H. Neumayer, N. Lachmann. (2011) Comparison between bortezomib and rituximab in the treatment of antibody-mediated renal allograft rejection. Nephrology Dialysis Transplantation
CrossRef25
C. Lefaucheur, C. Antoine, C. Suberbielle, D. Glotz. (2011) Mastering the Risk of HLA Antibodies in Kidney Transplantation: An Algorithm Based on Pretransplant Single-Antigen Flow Bead Techniques. American Journal of Transplantation 11:8, 1592-1598
CrossRef26
Sophoclis P. Alexopoulos. (2011) Editorial comment. Current Opinion in Organ Transplantation 16:4, 379
CrossRef27
Andrea Zachary, Nancy L. Reinsmoen. (2011) Quantifying HLA-specific antibodies in patients undergoing desensitization. Current Opinion in Organ Transplantation 16:4, 410-415
CrossRef28
Robert A. Montgomery, Emanuele Cozzi, Lori J. West, Daniel S. Warren. (2011) Humoral immunity and antibody-mediated rejection in solid organ transplantation. Seminars in Immunology 23:4, 224-234
CrossRef29
Robert A. Montgomery, Bonnie E. Lonze, Annette M. Jackson. (2011) Using donor exchange paradigms with desensitization to enhance transplant rates among highly sensitized patients. Current Opinion in Organ Transplantation 16:4, 439-443
CrossRef30
S Raghavaiah, M D Stegall. (2011) New Therapeutic Approaches to Antibody-Mediated Rejection in Renal Transplantation. Clinical Pharmacology & Therapeutics 90:2, 310-315
CrossRef31
Stanley C. Jordan, Joseph Kahwaji, Mieko Toyoda, Ashley Vo. (2011) B-cell immunotherapeutics. Current Opinion in Organ Transplantation 16:4, 416-424
CrossRef32
Montgomery, Robert A., Lonze, Bonnie E., King, Karen E., Kraus, Edward S., Kucirka, Lauren M., Locke, Jayme E., Warren, Daniel S., Simpkins, Christopher E., Dagher, Nabil N., Singer, Andrew L., Zachary, Andrea A., Segev, Dorry L., . (2011) Desensitization in HLA-Incompatible Kidney Recipients and Survival. New England Journal of Medicine 365:4, 318-326
Full Text33
Chih-Hung Lai, Kai Cao, Geraldine Ong, Mehrnoush Naim, Qi Wang, James Mirocha, Ashley Vo, Stanley C. Jordan, Nancy L. Reinsmoen. (2011) Antibody Testing Strategies for Deceased Donor Kidney Transplantation After Immunomodulatory Therapy. Transplantation 92:1, 48-53
CrossRef34
Silke V. Niederhaus, Brenda Muth, David F. Lorentzen, Philip Wai, John D. Pirsch, Milagros Samaniego-Picota, Glen E. Leverson, Anthony M. DʼAlessandro, Hans W. Sollinger, Arjang Djamali. (2011) Luminex-Based Desensitization Protocols: The University of Wisconsin Initial Experience. Transplantation 92:1, 12-17
CrossRef35
N. Tanimine, K. Ide, M. Yamashita, Y. Tanaka, Y. Igarashi, M. Banshodani, H. Tazawa, N.B. Basnet, M. Doskali, T. Onoe, H. Tashiro, H. Ohdan. (2011) Kinetics of Cellular and Humoral Immunity in a Successful Case of Positive Crossmatch Kidney Transplantation: A Case Report. Transplantation Proceedings 43:6, 2411-2414
CrossRef36
Martijn WF van den Hoogen, Luuk B Hilbrands. (2011) Use of monoclonal antibodies in renal transplantation. Immunotherapy 3:7, 871-880
CrossRef37
A M Azimzadeh, J R Lees, Y Ding, J S Bromberg. (2011) Immunobiology of Transplantation: Impact on Targets for Large and Small Molecules. Clinical Pharmacology & Therapeutics 90:2, 229-242
CrossRef38
Jagadeesh Bayry, Vir Singh Negi, Srini V. Kaveri. (2011) Intravenous immunoglobulin therapy in rheumatic diseases. Nature Reviews Rheumatology 7:6, 349-359
CrossRef39
Peter P. Reese, Harold I. Feldman, Roy D. Bloom, Peter L. Abt, Arwin Thomasson, Justine Shults, Robert Grossman, David A. Asch. (2011) Assessment of Variation in Live Donor Kidney Transplantation Across Transplant Centers in the United States. Transplantation 91:12, 1357-1363
CrossRef40
R. A. Montgomery. (2011) Living donor exchange programs: theory and practice. British Medical Bulletin 98:1, 21-30
CrossRef41
Isabel Roberti, Stuart Geffner, Shefali Vyas. (2011) Successful rescue of refractory acute antibody-mediated renal allograft rejection with splenectomy - A case report. Pediatric Transplantationno-no
CrossRef42
J. A. Bradley, W. M. Baldwin, A. Bingaman, C. Ellenrieder, H. M. Gebel, D. Glotz, A. D. Kirk. (2011) Antibody-Mediated Rejection-An Ounce of Prevention Is Worth a Pound of Cure. American Journal of Transplantation 11:6, 1131-1139
CrossRef43
Tereza Martinu, Elizabeth N. Pavlisko, Dong-Feng Chen, Scott M. Palmer. (2011) Acute Allograft Rejection: Cellular and Humoral Processes. Clinics in Chest Medicine 32:2, 295-310
CrossRef44
Hooi Sian Eng, Mary S. Leffell. (2011) Histocompatibility testing after fifty years of transplantation. Journal of Immunological Methods 369:1-2, 1-21
CrossRef45
Patrizia Amico, Patricia Hirt-Minkowski, Gideon Hönger, Lorenz Gürke, Michael J Mihatsch, Jürg Steiger, Helmut Hopfer, Stefan Schaub. (2011) Risk stratification by the virtual crossmatch: a prospective study in 233 renal transplantations. Transplant International 24:6, 560-569
CrossRef46
Stanley C Jordan, Mieko Toyoda, Ashley A Vo. (2011) Regulation of immunity and inflammation by intravenous immunoglobulin: relevance to solid organ transplantation. Expert Review of Clinical Immunology 7:3, 341-348
CrossRef47
Allison Webber, Ryutaro Hirose, Flavio Vincenti. (2011) Novel Strategies in Immunosuppression: Issues in Perspective. Transplantation 91:10, 1057-1064
CrossRef48
Carrie L. Kitko, John E. Levine, Dana C. Matthews, Paul A. Carpenter. (2011) Successful unrelated donor cord blood transplantation for Glanzmann’s thrombasthenia. Pediatric Transplantation 15:3, e42-e46
CrossRef49
C. Morath, G. Opelz, M. Zeier, C. Süsal. (2011) Kidney Transplantation for High-Risk Sensitized Patients – The “Heidelberg Algorithm”. Transplantation Proceedings 43:3, 801-804
CrossRef50
Shili Ge, Andy Pao, Ashley Vo, Nathan Deer, Artur Karasyov, Anna Petrosyan, Joseph Kahwaji, Marina Lukovsky, Ning-Ning Chai, Angela Aguiluz, James Mirocha, Stanley C. Jordan, Mieko Toyoda. (2011) Immunologic parameters and viral infections in patients desensitized with intravenous immunoglobulin and rituximab. Transplant Immunology 24:3, 142-148
CrossRef51
Christian Morath, Jan Schmidt, Gerhard Opelz, Martin Zeier, Caner Süsal. (2011) Kidney transplantation in highly sensitized patients: are there options to overcome a positive crossmatch?. Langenbeck's Archives of Surgery 396:4, 467-474
CrossRef52
Qing Ren, Anil Paramesh, C. Lillian Yau, Mary Killackey, Douglas Slakey, Sandy Florman, Joseph Buell, Brent Alper, Eric Simon, L. Lee Hamm, Rubin Zhang. (2011) Long-term outcome of highly sensitized African American patients transplanted with deceased donor kidneys. Transplant International 24:3, 259-265
CrossRef53
Weijie Zhang, Dong Chen, Zhishui Chen, Fanjun Zeng, Changsheng Ming, Zhengbin Lin, Ping Zhou, Gang Chen, Xiaoping Chen. (2011) Successful kidney transplantation in highly sensitized patients. Frontiers of Medicine 5:1, 80-85
CrossRef54
C. Süsal, C. Morath. (2011) Current approaches to the management of highly sensitized kidney transplant patients. Tissue Antigens 77:3, 177-186
CrossRef55
Lionel Couzi, Caroline Araujo, Gwendaline Guidicelli, Thomas Bachelet, Karine Moreau, Delphine Morel, Grégoire Robert, Hervé Wallerand, Jean-François Moreau, Jean-Luc Taupin, Pierre Merville. (2011) Interpretation of Positive Flow Cytometric Crossmatch in the Era of the Single-Antigen Bead Assay. Transplantation 91:5, 527-535
CrossRef56
N. Barnett, A. Dorling, N. Mamode. (2011) B cells in renal transplantation: pathological aspects and therapeutic interventions. Nephrology Dialysis Transplantation 26:3, 767-774
CrossRef57
S. C. Jordan, M. Toyoda, J. Kahwaji, A. A. Vo. (2011) Clinical Aspects of Intravenous Immunoglobulin Use in Solid Organ Transplant Recipients. American Journal of Transplantation 11:2, 196-202
CrossRef58
L. Lantieri, M. Hivelin, V. Audard, M. D. Benjoar, J. P. Meningaud, F. Bellivier, N. Ortonne, J.- P. Lefaucheur, A. Gilton, C. Suberbielle, J. Marty, P. Lang, P. Grimbert. (2011) Feasibility, Reproducibility, Risks and Benefits of Face Transplantation: A Prospective Study of Outcomes. American Journal of Transplantation 11:2, 367-378
CrossRef59
Kyle L. Dawson, Samir J. Patel, Jiaqiong Xu, Richard J. Knight, A. Osama Gaber. (2011) Effect of Immunosuppression for First Kidney or Kidney/Pancreas Transplant on Sensitization at the Time of Second Transplant. Transplantation1
CrossRef60
Sajid M. George, Rasheed A. Balogun, Scott L. Sanoff. (2011) Therapeutic apheresis before and after kidney transplantation. Journal of Clinical Apheresis 26:5, 252-260
CrossRef61
Seong Min Kim, Joon Seok Oh, Jee Min Jun, Yong Kee Park, Yong Hun Sin, Joong Kyung Kim, Kill Huh, Yong Jin Kim. (2011) A Case of Late Mixed Acute Humoral and Cellular Rejection Successfully Treated with Rituximab, Plasmapheresis and IVIg. The Journal of the Korean Society for Transplantation 25:2, 116
CrossRef62
Renaud Snanoudj, Sophie Candon, Christophe Legendre. (2010) Targeting B cells in sensitized kidney transplant patients: state of the art and future perspectives. Current Opinion in Organ Transplantation 15:6, 709-715
CrossRef63
Anne Scemla, Alexandre Loupy, Sophie Candon, Marie-France Mamzer, Frank Martinez, Julien Zuber, Rebecca Sberro, Chistophe Legendre, Eric Thervet. (2010) Incidence of Infectious Complications in Highly Sensitized Renal Transplant Recipients Treated by Rituximab: A Case-Controlled Study. Transplantation 90:11, 1180-1184
CrossRef64
Roslyn B Mannon. (2010) Immune monitoring and biomarkers to predict chronic allograft dysfunction. Kidney International 78, S59-S65
CrossRef65
James M. Gloor. (2010) The utility of comprehensive assessment of donor specific anti-HLA antibodies in the clinical management of pediatric kidney transplant recipients. Pediatric Transplantationno-no
CrossRef66
T Hoshino, T Sakura, K Miyawaki, N Hatsumi, S Takada, E Maruya, H Saji, S Miyawaki. (2010) Successful engraftment of a second transplant from unrelated cord blood identifying acceptable HLA Ag mismatches as treatment for primary graft failure possibly mediated by anti-HLA Abs after ‘mega-dose’ haploidentical PBSC transplantation. Bone Marrow Transplantation 45:11, 1665-1667
CrossRef67
Maarten G. J. Snoeijs, Bjorn Winkens, Martin B. A. Heemskerk, Andries J. Hoitsma, Maarten H. L. Christiaans, Wim A. Buurman, L. W. Ernest van Heurn. (2010) Kidney Transplantation From Donors After Cardiac Death: A 25-Year Experience. Transplantation 90:10, 1106-1112
CrossRef68
A. Lemy, M. Toungouz, D. Abramowicz. (2010) Bortezomib: a new player in pre- and post-transplant desensitization?. Nephrology Dialysis Transplantation 25:11, 3480-3489
CrossRef69
Peter M. Eckman, Mazen Hanna, David O. Taylor, Randall C. Starling, Gonzalo V. Gonzalez-Stawinski. (2010) Management of the sensitized adult heart transplant candidate. Clinical Transplantation 24:6, 726-734
CrossRef70
Joseph Kahwaji, Ashley A Vo, Stanley C Jordan. (2010) ABO blood group incompatibility: a diminishing barrier to successful kidney transplantation?. Expert Review of Clinical Immunology 6:6, 893-900
CrossRef71
Schwartz, Robert S., , Nankivell, Brian J., Alexander, Stephen I., . (2010) Rejection of the Kidney Allograft. New England Journal of Medicine 363:15, 1451-1462
Full Text72
Takafumi Machimoto, Giselle Guerra, George Burke, Frederick Jay Fricker, Jane Colona, Phillip Ruiz, Herwig-Ulf Meier-Kriesche, Juan Scornik. (2010) Effect of IVIG administration on complement activation and HLA antibody levels. Transplant International 23:10, 1015-1022
CrossRef73
Stanley C. Jordan, Nancy L. Reinsmoen, Ashley A. Vo. (2010) Intravenous Immunoglobulin and Rituximab for Desensitization. Transplantation 90:8, 932-933
CrossRef74
Stanley C. Jordan, Nancy Reinsmoen, Alice Peng, Chih-Hung Lai, Kai Cao, Rafael Villicana, Mieko Toyoda, Joseph Kahwaji, Ashley A. Vo. (2010) Advances in diagnosing and managing antibody-mediated rejection. Pediatric Nephrology 25:10, 2035-2048
CrossRef75
Peter M Eckman. (2010) Immunosuppression in the sensitized heart transplant recipient. Current Opinion in Organ Transplantation 15:5, 650-656
CrossRef76
B. E. Lonze, N. N. Dagher, C. E. Simpkins, J. E. Locke, A. L. Singer, D. L. Segev, A. A. Zachary, R. A. Montgomery. (2010) Eculizumab, Bortezomib and Kidney Paired Donation Facilitate Transplantation of a Highly Sensitized Patient Without Vascular Access. American Journal of Transplantation 10:9, 2154-2160
CrossRef77
Christian Morath, Jörg Beimler, Gerhard Opelz, Jörg Ovens, Sabine Scherer, Jan Schmidt, Bruno Schmied, Marie-Luise Gross, Vedat Schwenger, Martin Zeier, Caner Süsal. (2010) An Integrative Approach for the Transplantation of High-Risk Sensitized Patients. Transplantation 90:6, 645-653
CrossRef78
Joseph W. Rossano, David L.S. Morales, Farhan Zafar, Susan W. Denfield, Jeffrey J. Kim, John L. Jefferies, William J. Dreyer. (2010) Impact of antibodies against human leukocyte antigens on long-term outcome in pediatric heart transplant patients: An analysis of the United Network for Organ Sharing database. The Journal of Thoracic and Cardiovascular Surgery 140:3, 694-699.e2
CrossRef79
G. Bartel, M. Wahrmann, H. Regele, Ž. Kikić, G. Fischer, W. Druml, F. Mühlbacher, G. A. Böhmig. (2010) Peritransplant Immunoadsorption for Positive Crossmatch Deceased Donor Kidney Transplantation. American Journal of Transplantation 10:9, 2033-2042
CrossRef80
Mark D Stegall, Suresh Raghavaiah, James M Gloor. (2010) The (re)emergence of B cells in organ transplantation. Current Opinion in Organ Transplantation 15:4, 451-455
CrossRef81
V. Schwenger, C. Morath. (2010) Immunoadsorption in nephrology and kidney transplantation. Nephrology Dialysis Transplantation 25:8, 2407-2413
CrossRef82
Toshio Takagi, Hideki Ishida, Hiroki Shirakawa, Tomokazu Shimizu, Kazunari Tanabe. (2010) Changes in anti-HLA antibody titers more than 1year after desensitization therapy with rituximab in living-donor kidney transplantation. Transplant Immunology 23:4, 220-223
CrossRef83
Nurmamet Amet, Mercedes Gacad, Anna Petrosyan, Andy Pao, Stanley C. Jordan, Mieko Toyoda. (2010) In vitro effects of everolimus and intravenous immunoglobulin on cell proliferation and apoptosis induction in the mixed lymphocyte reaction. Transplant Immunology 23:4, 170-173
CrossRef84
Rob Higgins, David Lowe, Mark Hathaway, For T Lam, Habib Kashi, Lam Chin Tan, Chris Imray, Simon Fletcher, Klaus Chen, Nithya Krishnan, Rizwan Hamer, Daniel Zehnder, David Briggs. (2010) Double Filtration Plasmapheresis in Antibody-Incompatible Kidney Transplantation. Therapeutic Apheresis and Dialysis 14:4, 392-399
CrossRef85
Mieko Toyoda, Shili Ge, Andy Pao, Ashley Vo, Nathan Deer, Angela Aguiluz, Artur Karasyov, Stanley C. Jordan. (2010) Cellular allo reactivity against paternal HLA antigens in normal multiparous females as detected by intracellular cytokine flow cytometry remains elevated over years despite diminution of anti-HLA antibody levels. Transplant Immunology 23:3, 133-140
CrossRef86
Kavita G. Sharma, Raju Radha, Andy Pao, Nurmamet Amet, Lara Baden, Stanley C. Jordan, Mieko Toyoda. (2010) Mycophenolic acid and intravenous immunoglobulin exert an additive effect on cell proliferation and apoptosis in the mixed lymphocyte reaction. Transplant Immunology 23:3, 117-120
CrossRef87
Alexandre Loupy, Caroline Suberbielle-Boissel, Julien Zuber, Dany Anglicheau, Marc-Olivier Timsit, Frank Martinez, Eric Thervet, Patrick Bruneval, Dominique Charron, Gary S. Hill, Dominique Nochy, Christophe Legendre. (2010) Combined Posttransplant Prophylactic IVIg/Anti-CD 20/Plasmapheresis in Kidney Recipients With Preformed Donor-Specific Antibodies: A Pilot Study. Transplantation 89:11, 1403-1410
CrossRef88
B. Kaplan, T. Jie, R. Diana, J. Renz, A. Whinery, N. Stubbs, E. Bracamonte, C. Spier, P. Schubart, H. Rilo, R. Gruessner. (2010) Histopathology and Immunophenotype of the Spleen During Acute Antibody-Mediated Rejection. American Journal of Transplantation 10:5, 1316-1320
CrossRef89
Ashley A. Vo, Alice Peng, Mieko Toyoda, Joseph Kahwaji, Kai Cao, Chih-Hung Lai, Nancy L. Reinsmoen, Rafael Villicana, Stanley C. Jordan. (2010) Use of Intravenous Immune Globulin and Rituximab for Desensitization of Highly HLA-Sensitized Patients Awaiting Kidney Transplantation. Transplantation 89:9, 1095-1102
CrossRef90
Andrea A Zachary, Mary S Leffell. (2010) Barriers to successful transplantation of the sensitized patient. Expert Review of Clinical Immunology 6:3, 449-460
CrossRef91
James Gloor, Mark D. Stegall. (2010) Sensitized renal transplant recipients: current protocols and future directions. Nature Reviews Nephrology 6:5, 297-306
CrossRef92
Ashima Gulati, Minnie M Sarwal. (2010) Pediatric renal transplantation: an overview and update. Current Opinion in Pediatrics 22:2, 189-196
CrossRef93
Shahrooz S. Kelishadi, Agnes M. Azimzadeh, Tianshu Zhang, Tiffany Stoddard, Emily Welty, Christopher Avon, Mitch Higuchi, Amal Laaris, Xiang-Fei Cheng, Christine McMahon, Richard N. Pierson. (2010) Preemptive CD20+ B cell depletion attenuates cardiac allograft vasculopathy in cyclosporine-treated monkeys. Journal of Clinical Investigation 120:4, 1275-1284
CrossRef94
Ron Shapiro, Minnie M. Sarwal. (2010) Pediatric Kidney Transplantation. Pediatric Clinics of North America 57:2, 393-400
CrossRef95
Robert A. Montgomery. (2010) Renal Transplantation Across HLA and ABO Antibody Barriers: Integrating Paired Donation into Desensitization Protocols. American Journal of Transplantation 10:3, 449-457
CrossRef96
Mieko Toyoda, Andy Pao, Ashley Vo, Marina Lukovsky, Raju Radha, Tetsu Sado, Shili Ge, Nancy Reinsmoen, Ning Ning Chai, Lara Baden, Anna Petrosyan, Edwina Skinner, James Mirocha, Stanley C. Jordan. (2010) Intracellular IFNγ production in CD3 negative cells exposed to allo-antigens is an indicator of prior sensitization. Transplant Immunology 22:3-4, 121-127
CrossRef97
N. Kamar, O. Milioto, B. Puissant-Lubrano, L. Esposito, M. C. Pierre, A. Ould Mohamed, L. Lavayssière, O. Cointault, D. Ribes, I. Cardeau, M. B. Nogier, D. Durand, M. Abbal, A. Blancher, L. Rostaing. (2010) Incidence and Predictive Factors for Infectious Disease after Rituximab Therapy in Kidney-Transplant Patients. American Journal of Transplantation 10:1, 89-98
CrossRef98
J. M. Cecka. (2010) Calculated PRA (CPRA): The New Measure of Sensitization for Transplant Candidates. American Journal of Transplantation 10:1, 26-29
CrossRef99
Stanley C. Jordan, Mieko Toyoda. 2010. Transplant Immunology. , 356-363.
CrossRef100
S. C. Jordan, D. Glotz. (2010) Is Rituximab Safe to Use in Kidney Transplant Patients?. American Journal of Transplantation 10:1, 8-9
CrossRef101
Nadine Shehata, Valerie A. Palda, Ralph M. Meyer, Tom D. Blydt-Hansen, Patricia Campbell, Carl Cardella, Steven Martin, Peter Nickerson, Kevork Peltekian, Heather Ross, Tom K. Waddell, Lori West, David Anderson, John Freedman, Heather Hume. (2010) The Use of Immunoglobulin Therapy for Patients Undergoing Solid Organ Transplantation: An Evidence-Based Practice Guideline. Transfusion Medicine Reviews 24, S7-S27
CrossRef102
Ashley A. Vo, George E. Chaux, Jeremy A. Falk. 2010. Transplant Pharmacology. , 352-356.
CrossRef103
SUE PONDROM. (2010) The AJT Report: News and issues that affect organ and tissue transplantation. American Journal of Transplantation 10:1, 2-4
CrossRef104
H.-P. Hartung, L. Mouthon, R. Ahmed, S. Jordan, K. B. Laupland, S. Jolles. (2009) Clinical applications of intravenous immunoglobulins (IVIg) - beyond immunodeficiencies and neurology. Clinical & Experimental Immunology 158, 23-33
CrossRef105
Esther Wilk, Torsten Witte, Nicole Marquardt, Tibor Horvath, Katy Kalippke, Kirsten Scholz, Nadine Wilke, Reinhold E. Schmidt, Roland Jacobs. (2009) Depletion of functionally active CD20+ T cells by rituximab treatment. Arthritis & Rheumatism 60:12, 3563-3571
CrossRef106
Patrizia Amico, Gideon Hönger, Jürg Steiger, Stefan Schaub. (2009) Utility of the virtual crossmatch in solid organ transplantation. Current Opinion in Organ Transplantation 14:6, 656-661
CrossRef107
Jason Rhee, Nora Al-Mana, Richard Freeman. (2009) Immunosuppression in high-risk transplantation. Current Opinion in Organ Transplantation 14:6, 636-642
CrossRef108
Ronald F Parsons, Kumar Vivek, Robert R Redfield, Thi-Sau Migone, Michael P Cancro, Ali Naji, Hooman Noorchashm. (2009) B-cell tolerance in transplantation: is repertoire remodeling the answer?. Expert Review of Clinical Immunology 5:6, 703-723
CrossRef109
Josef Stehlik, Nauman Islam, Denise Hurst, Abdallah G. Kfoury, Matthew A. Movsesian, Ann Fuller, Julio C. Delgado, M. Elizabeth H. Hammond, Edward M. Gilbert, Dale G. Renlund, Feras Bader, Patrick W. Fisher, David A. Bull, Arun K. Singhal, David D. Eckels. (2009) Utility of Virtual Crossmatch in Sensitized Patients Awaiting Heart Transplantation. The Journal of Heart and Lung Transplantation 28:11, 1129-1134
CrossRef110
Frans HJ Claas, Ilias IN Doxiadis. (2009) Management of the highly sensitized patient. Current Opinion in Immunology 21:5, 569-572
CrossRef111
S. Heidt, D. L. Roelen, C. Eijsink, M. Eikmans, F. H. J. Claas, A. Mulder. (2009) Intravenous immunoglobulin preparations have no direct effect on B cell proliferation and immunoglobulin production. Clinical & Experimental Immunology 158:1, 99-105
CrossRef112
Madeleine Ingelsten, Karin Gustafsson, Mihai Oltean, Alex Karlsson-Parra, Michael Olausson, Börje Haraldsson, Jenny Nyström. (2009) Is Indoleamine 2,3-Dioxygenase Important for Graft Acceptance in Highly Sensitized Patients After Combined Auxiliary Liver-Kidney Transplantation?. Transplantation 88:7, 911-919
CrossRef113
Paolo Cravedi, Roslyn B Mannon. (2009) Noninvasive methods to assess the risk of kidney transplant rejection. Expert Review of Clinical Immunology 5:5, 535-546
CrossRef114
Robert A Bray, Howard M Gebel. (2009) Strategies for human leukocyte antigen antibody detection. Current Opinion in Organ Transplantation 14:4, 392-397
CrossRef115
Mary S Leffell, Andrea A Zachary. (2009) The role of the histocompatibility laboratory in desensitization for transplantation. Current Opinion in Organ Transplantation 14:4, 398-402
CrossRef116
Isabel P Neuringer, Peadar Noone, Rebecca K Cicale, Ken Davis, Robert M Aris. (2009) Managing complications following lung transplantation. Expert Review of Respiratory Medicine 3:4, 403-423
CrossRef117
Vickie McDonald, Maria Leandro. (2009) Rituximab in non-haematological disorders of adults and its mode of action. British Journal of Haematology 146:3, 233-246
CrossRef118
Frans H. J. Claas, Axel Rahmel, IIias I. N. Doxiadis. (2009) Enhanced Kidney Allocation to Highly Sensitized Patients by the Acceptable Mismatch Program. Transplantation 88:4, 447-452
CrossRef119
Ilias IN Doxiadis, Frans HJ Claas. (2009) Transplantation of highly sensitized patients via the acceptable mismatch program or desensitization? We need both. Current Opinion in Organ Transplantation 14:4, 410-413
CrossRef120
A.L. Lobashevsky, J.E. Manwaring, M.M. Travis, B.L. Nord, N.G. Higgins, Y.A. Serov, T.S. Arnoff, G.A. Hommel-Berrey, W.C. Goggins, T.E. Taber, C.B. Carter, D.S. Smith, T.C. Wozniak, J.A. O'Donnell, M.W. Turrentine. (2009) Effect of desensitization in solid organ transplant recipients depends on some cytokines genes polymorphism. Transplant Immunology 21:3, 169-178
CrossRef121
Stanley C. Jordan, Mieko Toyoda, Ashley A. Vo. (2009) Intravenous Immunoglobulin a Natural Regulator of Immunity and Inflammation. Transplantation 88:1, 1-6
CrossRef122
Herwig-Ulf Meier-Kriesche, Juan C. Scornik, Brian Susskind, Shehzad Rehman, Jesse D. Schold. (2009) A Lifetime Versus a Graft Life Approach Redefines the Importance of HLA Matching in Kidney Transplant Patients. Transplantation 88:1, 23-29
CrossRef123
Jagadeesh Bayry, Sébastien Lacroix-Desmazes, Srini V. Kaveri. (2009) Novel therapeutic strategies for multiple sclerosis: potential of intravenous immunoglobulin. Nature Reviews Drug Discovery 8:7, 594-594
CrossRef124
Jeremy L. Hensley, Costi D. Sifri, Helen P. Cathro, Peter Lobo, Robert G. Sawyer, Kenneth L. Brayman, Robert C. Hackman, Timothy L. Pruett, Hugo J. R. Bonatti. (2009) Adenoviral graft-nephritis: case report and review of the literature. Transplant International 22:6, 672-677
CrossRef125
Renato Guzman Moreno. (2009) B-cell depletion in autoimmune diseases. Autoimmunity Reviews 8:7, 585-590
CrossRef126
K. L. Womer, B. Kaplan. (2009) Recent Developments in Kidney Transplantation-A Critical Assessment. American Journal of Transplantation 9:6, 1265-1271
CrossRef127
Thomas Fehr, Barbara Rüsi, Andreas Fischer, Helmut Hopfer, Rudolf P. Wüthrich, Ariana Gaspert. (2009) Rituximab and Intravenous Immunoglobulin Treatment of Chronic Antibody-Mediated Kidney Allograft Rejection. Transplantation 87:12, 1837-1841
CrossRef128
Dessislava Kopchaliiska, Andrea A. Zachary, Robert A. Montgomery, Mary S. Leffell. (2009) Reconstitution of Peripheral Allospecific CD19+ B-Cell Subsets After B-Lymphocyte Depletion Therapy in Renal Transplant Patients. Transplantation 87:9, 1394-1401
CrossRef129
D. A. Axelrod, K. L. Lentine, P. R. Salvalaggio, M. A. Schnitzler. (2009) The Cost and Quality Paradox. American Journal of Transplantation 9:5, 985-986
CrossRef130
C. Lefaucheur, D. Nochy, J. Andrade, J. Verine, C. Gautreau, D. Charron, G. S. Hill, D. Glotz, C. Suberbielle-Boissel. (2009) Comparison of Combination Plasmapheresis/IVIg/Anti-CD20 Versus High-Dose IVIg in the Treatment of Antibody-Mediated Rejection. American Journal of Transplantation 9:5, 1099-1107
CrossRef131
Jörg H. M. Beimler, Christian Morath, Jan Schmidt, Jörg Ovens, Gerhard Opelz, Axel Rahmel, Martin Zeier, Caner Süsal. (2009) Successful Deceased-Donor Kidney Transplantation in Crossmatch-Positive Patients With Peritransplant Plasma Exchange and Rituximab. Transplantation 87:5, 668-671
CrossRef132
Mohan S. Maddur, Sébastien Lacroix-Desmazes, Jagadeesh Bayry, Srini V. Kaveri. (2009) Intravenous polyclonal immunoglobulin in autoimmune diseases: clinical indications and mechanisms of action. Drug Discovery Today: Therapeutic Strategies 6:1, 5-11
CrossRef133
Monica Grafals, Anil Chandraker. (2009) New Approaches For Desensitization Strategies Prior to Kidney Transplantation. American Journal of Kidney Diseases 53:3, 370-372
CrossRef134
Arti Nanda. (2009) How effective are intravenous immunoglobulins in pediatric dermatology?. Expert Review of Dermatology 4:1, 37-45
CrossRef135
Sujit Itty, Jose S. Pulido. (2009) Rituximab for Intraocular Lymphoma. Retina 29:2, 129-132
CrossRef136
J. E. Locke, C. M. Magro, A. L. Singer, D. L. Segev, M. Haas, A. T. Hillel, K. E. King, E. Kraus, L. M. Lees, J. K. Melancon, Z. A. Stewart, D. S. Warren, A. A. Zachary, R. A. Montgomery. (2009) The Use of Antibody to Complement Protein C5 for Salvage Treatment of Severe Antibody-Mediated Rejection. American Journal of Transplantation 9:1, 231-235
CrossRef137
Neha Nainani, Neeraj Singh, Thomas Shanahan, Amar Damodar, Nakul Parimoo, Sudheer Ummadi, Yasir Qazi, Brian M. Murray, Kathleen M. Tornatore, James C. Ciccirella, George A. Blessios, Rocco C. Venuto. (2009) Cross Reactive Epitope Group antibodies in sensitized kidneys transplant recipients was associated with early acute Antibody Mediated Rejection. Transplant Immunology 20:3, 113-117
CrossRef138
George V. Mazariegos, Kyle Soltys, Geoffrey Bond, Alin Girnita, Zurab Machaidze, Ronald Jaffe, Michael Green, Dolly Martin, Adriana Zeevi, Robert Squires, Graciela Perez, Kareem Abu-Elmagd, Rakesh Sindhi. (2008) Pediatric Intestinal Retransplantation: Techniques, Management, and Outcomes. Transplantation 86:12, 1777-1782
CrossRef139
(2008) Desensitization for renal transplantation with rituximab and intravenous immune globulin. Nature Clinical Practice Nephrology 4:11, 586-586
CrossRef140
(2008) Desensitization during Renal Transplantation. New England Journal of Medicine 359:16, 1731-1732
Full Text141
(2008) Journal Club. Kidney International 74:7, 841-842
CrossRef142
Nancy L. Reinsmoen, Chih-Hung Lai, Ashley Vo, Kai Cao, Geraldine Ong, Mehrnoush Naim, Qi Wang, Stanley C. Jordan. (2008) Acceptable Donor-Specific Antibody Levels Allowing for Successful Deceased and Living Donor Kidney Transplantation After Desensitization Therapy. Transplantation 86:6, 820-825
CrossRef143
Jacyntha A. Sterling. (2008) Hospital Pharmacy Pulse - Recent Publications on Medications and Pharmacy. Hospital Pharmacy 43:9, 770-776
CrossRef144
C.A. O'Callaghan. (2008) Kidney transplantation--the long term view. QJM 101:12, 985-986
CrossRef145
Shapiro, Ron, . (2008) Reducing Antibody Levels in Patients Undergoing Transplantation. New England Journal of Medicine 359:3, 305-306
Full Text
- Letters
