Impact of Pretransplant Rituximab on Kidney Graft in Highly-Sensitized Recipients; Compared with Non-Rituximab Group

Abstract

Background: Highly sensitized patients with a high level of panel reactive antibody (PRA) can have more episodes of antibody-mediated rejection (AMR) and poorer graft survival than non-sensitized patients. Rituximab is a well known monoclonal anti-CD20 antibody for the depletion of B lymphocyte. The study aim was to compare a rituximab-administered group with a non-administered group in highly sensitized recipients. Methods: We enrolled 43 patients with over 50% PRA (class I or II), who underwent living donor kidney transplantation. Sixteen patients (group R) received one dose (375mg/m2) of rituximab at 2 days prior to transplantation and 27 patients (group NR) did not. ABO-incompatible kidney transplantations were excluded. Results: Mean follow-up duration was 14.9 and 38.1 months in groups R and NR, respectively. The patients' demographics such as age, sex, dialysis duration and kind of immunosuppressive agent were not different between the two groups. There were no side effects from rituximab administration in group R. Class I PRA of group R (75.6±37.7%) was higher than that of group NR (45.7±35.8%; p=0.013). There were more acute rejection episodes within 1 year in group NR but the difference with group R was not significant (Table 1). However, two AMR episodes occurred only in group NR. The renal function of the two groups was not different. In group R, CD19 and CD20 rapidly decreased 2 days after rituximab infusion.[Figure 1.]Conclusion: There were no differences in cell-mediated rejection from the administration of rituximab. However, AMR tended to decrease in the rituximab group. To confirm the long-term anti-rejection and beneficial effect of rituximab, further study should be performed in a larger cohort. Rituximab administration 2 days prior to transplantation can be effective and safe.