Suppression of Panel-Reactive Antibodies by Treatment with Mycophenolate Mofetil

Abstract

"Panel Reactive Antibody" (PRA) testing is commonly used to assess the pretransplant antibody status in order to estimate the risk of an adverse humoral response following transplantation. We report on a female patient with end-stage cardiac failure suffering from acute myocarditis who underwent implantation of a left-ventricular assist device (Novacor, Baxter Healthcare Corp. Oakland, CA). During evaluation for heart transplantation, a PRA level of 50-70% was detected. After treatment with mycophenolate mofetil at a dosage of 2 g daily, PRA levels declined within one week to 0-5%, and remained low after discontinuation of the immunosuppressive drug. We feel that pretreatment of patients with elevated PRA levels with mycophenolate mofetil is well justified.

Pre-Transplant Panel Reactive Antibody in Lung Transplant Recipients is Associated with Significantly Worse Post-Transplant Survival in a Multicenter Study

“…Other approaches in other solid organ transplants have included the use of mycophenolate mofetil and cyclophosphamide before and after transplantation to reduce PRA. 33,34 Their effect in lung transplantation is unknown.…”

Use of Rituximab to Decrease Panel-Reactive Antibodies

“…Mycophenolate mofetil inhibits T-and B-lymphocyte reproduction 4 and has been effective in decreasing the %PRA. 5 An increased dose of mycophenolate mofetil may have been effective. However, because the patient had a prosthetic heart valve and an indwelling line (for delivery of inotropes and heparin), we were concerned about immunosuppressing him too aggressively.…”

“…Therefore, rituximab, a monoclonal antibody that binds to and causes the death of cells bearing the CD20 receptor, has an effect on B cells but not on plasma cells. 5,6 It is understandable that a rapid decrease in B cells would follow rituximab therapy but that %PRA would decrease slowly. Rituximab therapy offered 1 beneficial effect and a 2nd potentially beneficial effect.…”

Antibody-Mediated Rejection in Cardiac Transplantation: Emerging Knowledge in Diagnosis and Management

“…Both sirolimus and MMF profoundly inhibit B-cell proliferation and immunoglobulin production in a dose-dependent manner, compared with calcineurin inhibitors; both drugs induce significant B-cell apoptosis. [240][241][242][243] Although no longer commonly used, cyclophosphamide suppresses B-cell activation, proliferation, and differentiation and has been reportedly effective in AMR. 8,75,80,[244][245][246][247] Likewise, methotrexate has been reported as successful in treating refractory rejection but is not commonly used currently.…”