High-Dose Intravenous Immunoglobulin and Rituximab Treatment for Antibody-Mediated Rejection After Kidney Transplantation: A Cost Analysis

B. Tanriover; S. E. Wright; S. V. Foster; K. S. Roush; J. A. Castillo-Lugo; K. Fa; F. L. Levy; A. Mejia

doi:10.1016/j.transproceed.2008.08.131

High-Dose Intravenous Immunoglobulin and Rituximab Treatment for Antibody-Mediated Rejection After Kidney Transplantation: A Cost Analysis

B. Tanriover, S. E. Wright, S. V. Foster, K. S. Roush, J. A. Castillo-Lugo, K. Fa, F. L. Levy, A. Mejia

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23 Scopus citations

Abstract

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/m²) 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.

Original language	English (US)
Pages (from-to)	3393-3396
Number of pages	4
Journal	Transplantation proceedings
Volume	40
Issue number	10
DOIs	https://doi.org/10.1016/j.transproceed.2008.08.131
State	Published - Dec 2008

ASJC Scopus subject areas

Surgery
Transplantation

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10.1016/j.transproceed.2008.08.131

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title = "High-Dose Intravenous Immunoglobulin and Rituximab Treatment for Antibody-Mediated Rejection After Kidney Transplantation: A Cost Analysis",

abstract = "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/m2) 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.",

author = "B. Tanriover and Wright, {S. E.} and Foster, {S. V.} and Roush, {K. S.} and Castillo-Lugo, {J. A.} and K. Fa and Levy, {F. L.} and A. Mejia",

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AU - Wright, S. E.

AU - Foster, S. V.

AU - Roush, K. S.

AU - Castillo-Lugo, J. A.

AU - Fa, K.

AU - Levy, F. L.

AU - Mejia, A.

PY - 2008/12

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AB - 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/m2) 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.

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High-Dose Intravenous Immunoglobulin and Rituximab Treatment for Antibody-Mediated Rejection After Kidney Transplantation: A Cost Analysis

Abstract

ASJC Scopus subject areas

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