Abstract Background and Aims Pre-transplant sensitization is important risk factor for the development of antibody-mediated rejection (ABMR) and can result in inferior long-term allograft survival in kidney transplantation (KT). The aim of this study was to investigate the effect of pre-transplant Rituximab infusion on the clinical outcome in highly sensitized patients. Method The study included 128 consecutive recipients who received renal transplant between 05/2022 and 12/2023, of them 68 patients showed the result of panel-reactive antibody higher than 30%, but showed negative crossmatch test before transplantation. Out of them, 44 patients who took pre-transplant Rituximab at a dose of 375 mg/m2 belonged to Rituximab group and remained 24 patients were regarded as control group. We compared the development of ABMR, the change of allograft function and allograft survival rate between 2 groups after KT. Results Between two groups, no difference was found in baseline characteristics such as age at KT, gender, pre-transplant dialysis duration, primary renal disease. The mean value of PRA and HLA mismatching number, the type of main immunosuppressive agent did not differ as well. After KT, the development of ABMR was significantly lower in Rituximab group (5/44 (11.4%)) compared to control group (10/24 (41.7%), p < 0.005) and total rejection rate showed lower tendency in Rituximab group as well (p = 0.052). However, the incidence of CMV, fungal or bacterial infections was similar between the groups. Allograft function assessed by MDRD eGFR at 14 days after KT was significantly higher in Rituximab group compared to control group, but at 6 and 12 months from KT, it did not differ between two groups. Allograft rejection free survival was significantly higher in Rituximab group compared to control group (p < 0.05). Conclusion In sensitized patients with high PRA but negative crossmatch, Rituximab was effective to prevent the development of ABMR without an increased incidence of opportunistic infections.
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