More Kidney Transplants Feasible with Rituximab/IVIG Therapy

Author: Jody Cross

Researchers at Cedars-Sinai Medical Center in Los Angeles, California, have developed a promising new experimental therapy for use by patients awaiting kidney transplantation. The therapy combines Genentech's cancer drug Rituximab, sold under the brand name Rituxan, with infusions of intravenous immune globulin.

The new combo therapy reduced rejection rates, and improved outcomes, in a small sampling of kidney transplant patients, all of whom were previously considered to be poor candidates for transplantation surgery. It was also found to considerably improve the chances that a donor could be found for these hard-to-match patients.

The July, 2008, issue of the New England Journal of Medicine reported that approximately one-third of the 74,000 patients awaiting transplant surgery are considered to be poor candidates for the surgery because the risk is too high that their immune systems will reject a transplanted organ from all but the very closest-matching donors. This combo therapy can greatly raise the kidney transplant rate possible for these patients, moving it from less than 10 percent up to 80 percent. It is also less costly than when intravenous immune globulin therapy is used alone.

Participation in the Cedars-Sinai study was limited to 20 participants. After this new combo therapy, 16 of the 20 patients were able to undergo transplants. Prior to using this therapy the average wait time for these patients had been 12 years, and in one case 27 years. "These were people who were very difficult to match. They had been on the waiting list for many years. Less than 5 to 10 percent would have gotten a kidney," Dr. Jordon, the study's team leader said. With the use of this new combination therapy, acceptable donors were able to be found in an average of only five months.

The one-year patient survival rate of those patients who had transplants was 100 percent; and 94 percent of the grafts survived. Although half of the patients had an acute rejection episode, most were early and reversible; two patients had a late acute rejection episode.

The protocol has now been used on more than 100 patients with an 80 percent transplant rate, and the one-year success rate for the transplanted kidneys continues to be around 94 percent. As Dr. Jordan commented, "It's holding up very well with larger numbers."

Dr. Ashley Vo and the team at Cedars-Sinai noted that early transplantation has the potential to result in considerable costs savings, reduce morbidity and mortality, and improve the quality of life for patients who would otherwise be destined to remain on dialysis for many years while waiting for a kidney. Dr. Jordan emphasizes that from a quality-of-life perspective, as well as from a financial standpoint, transplantation is a much better option than years of dialysis.

Transplant surgery for these patients requires careful, long-term monitoring. More and larger studies are needed, but this work, "may have the potential to help thousands of patients who are languishing on waiting lists around the world," according to Ron Shapiro, M.D., of the Thomas E. Starzl Transplantation Institute at the University of Pittsburgh.