#4809 EFFECT OF RITUXIMAB DOSE ON INDUCTION THERAPY IN ABO-INCOMPATIBLE KIDNEY TRANSPLANTATION: A NETWORK META-ANALYSIS USING RECENT DATA

Abstract

Abstract Background and Aims Rituximab is an essential inducible immunosuppressive agent for ABO-incompatible kidney transplantation (ABOi KT). However, studies on the dosage by country and transplant center are lacking. Therefore, we retrospectively investigated the effects of rituximab induction doses on patient mortality, transplant failure and adverse events. Method We included studies mentioning at least two of the eligible induction doses (200 mg, 200–500 mg, or 500 mg) of rituximab during ABOi KT and associated outcomes such as patient survival, graft failure, and bacterial and viral infections. We performed direct and indirect network meta-analyses using a Bayesian model and ranked different rituximab doses using generational mixed treatment comparisons. Publications from 1970 to February 2020 were searched and analyzed using the CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded databases. GRADE of network meta-analysis approaches specified four levels of certainty for a given outcome: high, moderate, low, and very low. Results Among 5378 patients in 25 trials, glomerular filtration rate, graft loss, antibody-mediated rejection, T-cell-mediated rejection, fungal infection, bacterial infection, and CMV infection did not differ between ABOi groups treated with different doses of rituximab. The effect on mortality was significantly higher in the rituximab 200-500 mg and rituximab 500 mg groups (odds ratio [OR] 2.4, 95% CrI: 1.5-7.4 and OR 1.8.0, 95% CrI 1.2-11.2). The incidence of BK virus was significantly lower in the rituximab 200 mg group than in the other groups. Conclusion In ABO-incompatible kidney transplantation, low-dose rituximab is more effective than high-dose rituximab and reduces the risk of serious infection. Due to the small sample size, further randomized controlled trials may be needed to confirm these findings.