Presentation Authors: Kasumi Kawamura*, Motoo Araki, Yuki Maruyama, Yosuke Mitsui, Takuya Sadahira, Risa Kubota, Shingo Nishimura, Koichiro Wada, Yasuyuki Kobayashi, Toyohiko Watanabe, Yasutomo Nasu, Okayama, Japan
Introduction: Rituximab is a chimeric anti-CD20 monoclonal antibody that used to deplete B cells. In ABO-incompatible renal transplantation, rituximab is useful to expand the donor pool. However, rituximab often leads to an increase in infectious complications, late-onset neutropenia (LON). The aim of this study is to analyze effect and adverse event of rituximab as induction therapy in living-donor renal transplantation.
Methods: Ninety-two recipients undergoing living-donor renal transplantation in our institution from May 2009 to August 2018 were retrospectively evaluated. We excluded 4 recipients who were followed less than 3 months after renal transplantation. Indications of preoperative rituximab (200mg/body) are the following; 1. ABO major mismatch, 2. ABO minor mismatch, 3. de novo donor-specific anti-human leukocyte antigens antibodies (DSA) positive, 4. Focal segmental glomerulosclerosis (FSGS). This study was approved by Ethical Committee of Okayama University Hospital and the informed consent of the patients.
Results: There were 68 in rituximab group (Rit), and 20 in non-rituximab group (non-Rit). Median follow-up was 40 months. There were significant differences between two groups in age (median; 32 vs 47, p=0.01), but were no significant differences in sex (male: 68% vs 65% p=0.83), FSGS (0% vs 4%, p=0.35) or primary cytomegalovirus (CMV) infection (30% vs 15%, p=0.15). Serum creatinine did not demonstrate significant differences between two groups except 3 months after transplantation (median; 1.4 mL/min in Rit group vs 1.1 mL/min in non-Rit group, p=0.02). Acute injection (5% vs 7%, p=0.72), the use of G-CSF (25% vs 34%, p=0.54), CMV infection (26% vs 13%, p=0.15) and graft loss (11% vs 8%, p=0.15) demonstrated no significant differences between two groups.
Conclusions: Rituximab induction therapy is effective in immunological high risk recipients. It does not increase adverse event.