Rituximab is used off-label in solid organ transplant for desensitization and treatment of antibody-mediated rejection (AMR). It targets CD20 and results in B cell depletion. Although it may be beneficial in preventing or fighting rejection, its use may be associated with unfavorable infectious outcomes. The purpose of this study was to evaluate the incidence of infection in kidney transplant recipients who received rituximab for desensitization or AMR.

This was a single-center, retrospective analysis of living and deceased donor kidney transplant recipients at Northwestern Memorial Hospital from January 1, 2007 to October 1, 2015. The following were inclusion criteria: alemtuzumab induction; age 18 years or older; receipt of at least one dose of rituximab. Patients were excluded for: previous transplant; simultaneous organ transplants; rituximab for an oncologic indication; history of human immunodeficiency virus. The primary efficacy endpoint was incidence of infection over 1 year following first dose of rituximab. Secondary endpoints were patient and graft survival 1 year following first dose of rituximab.

Of the 145 subjects included, 114 (79%) received rituximab for desensitization and 31 (21%) for treatment of AMR. Overall, there were 34 cases of fungal and viral infections. Five patients had death-censored graft failure and 8 patients died within the study period, 2 which were attributed to sepsis. An analysis comparing those who received rituximab for desensitization versus AMR revealed no significant difference in incidence of infection, patient survival or graft survival.

Approximately 20% of patients receiving rituximab experienced a fungal or viral infection during the study period. The risk versus benefit of rituximab should be taken into consideration when identifying patients who may benefit from rituximab use. Further efforts to address patients at higher risk for these complications are warranted.

CITATION INFORMATION: Wong L, Ison M, Richardson C, Cunningham K, D'Agostino C, Tseng C, Shetty A. Incidence of Fungal and Viral Infections Following Rituximab Use in Kidney Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

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