IVIG and Rituximab Desensitization for Renal Transplantation Is Cost-Effective and May Improve Survival

A desensitization protocol using intravenous immune globulin (IVIG) and rituximab has been used for a number of years to allow renal transplantation in highly sensitized (HS) patients, defined as having panel reactive antibody (PRA) >80 percent. A series of 207 HS patients who were desensitized using IVIG and rituximab between July 2006 and December 2011 were compared with age, end-stage renal disease etiology and PRA-matched patients remaining on dialysis only during the study period. Costs and outcomes of desensitization were compared with dialysis.

Of the 207 treated patients, 146 proceeded to transplant. At 48 months, patient and graft survival by Kaplan-Meier were 95 percent and 87.5 percent, respectively. The total three-year cost for patients treated with the desensitization protocol was $219,914 per patient, compared with $238,667 per patient treated with dialysis. Overall, estimated patient survival at the end of three years was 96.6 percent for patients in the desensitization arm of the model, compared with 79.0 percent for the matched group of patients remaining on dialysis during the study period.

The investigators concluded that desensitization with IVIG and rituximab yields financial savings and an estimated 17.6 percent greater probability of three-year survival versus dialysis alone. These benefits of desensitization, however, are limited by organ availability and allocation policies.