Efficacy of Rituximab Sparing Protocol for ABO Incompatible Renal Transplant in Patients With Low Titers

S. Narumi,¹ Y. Watarai,¹ N. Goto,¹ T. Hiramitsu,¹ T. Yamamoto,¹ M. Tsujita,¹ M. Okada,¹ K. Futamura,¹ A. Takeda,² T. Kobayashi.³

¹Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Aichi, Japan
²Nephrology, Nagoya Daini Red Cross Hospital, Nagoya, Aichi, Japan
³Applied Immunology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.

Meeting: 2015 American Transplant Congress

Abstract number: C89

Keywords: Antibodies, Kidney transplantation, Mycophenolate mofetil, Plasmapheresis

Session Information

Session Name: Poster Session C: Kidney Immunosuppression: Desensitization

Session Type: Poster Session

Date: Monday, May 4, 2015

Session Time: 5:30pm-6:30pm

Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

[Introduction]Acute antibody mediated rejection (AMR) has been a major problem in ABO-incompatible kidney transplantation (ABOi-KTx), and currently mycophenolate mofetil and rituximab have been used to reduce the prevalence of AMR. We established rituximab sparing protocol for patients with low ABO titers. We present its efficacy and safety, and middle term results. [Patients and Methods] One hundred sixty-nine adult patients, 58 females and 111 males with a mean age of 51.3 years (15-79), underwent ABOi-KTx between January 2007 and December 2013. All patients received 2 weeks of mycophenolate mofetil and prednisolone before transplant, followed by calcineurin inhibitor (cyclosporine in 115 or tacrolimus in 54 cases) with basiliximab induction. Patients with starting titer of 32x or more (SD group: n=124) received low dose rituximab (100 or 200mg/body x2) and 4 times of pre-transplant plasmapheresis (PP). SD group included 7 patients with pre-existing donor specific antibody (DSA). For the patients with starting titer below 16x (LR group: n=45), rituximab was excluded from desensitization therapy and pre-transplant PP was reduced to 2 times. [Results]With a mean observation period of 41 (2-94) months, 3 and 5 years patient survival are 97.7% and 95.8% in SD group and 100% in LR group. Graft survival at 3 and 5 years are 96.1% and 90.7% in SD group and 95.8% and 95.8% (p=0.6456). Clinical and subclinical T cell mediated rejection was developed and was treated in 8.9% (11/124) of SD group and in 6.7 % (3/45) of LD group. Clinical and subclinical AMR were observed in 3.2% (4/124) of SD group and successfully treated with additional PP/IVIG and steroid pulse therapy but none developed AMR in LR group. Cytomegalovirus viremia/disease was observed 29.8% (37/124) of SD group and 17.7% (8/45) of LR group (p=0.11). [Conclusions] This study demonstrated that rituximab sparing desensitization protocol of ABOi-KTx in a low risk patient population is safe and effective. Amount of rituximab can be reduced in standard and high risk patients without significant increase in prevalence of AMR.

To cite this abstract in AMA style:

Narumi S, Watarai Y, Goto N, Hiramitsu T, Yamamoto T, Tsujita M, Okada M, Futamura K, Takeda A, Kobayashi T. Efficacy of Rituximab Sparing Protocol for ABO Incompatible Renal Transplant in Patients With Low Titers [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/efficacy-of-rituximab-sparing-protocol-for-abo-incompatible-renal-transplant-in-patients-with-low-titers/. Accessed June 2, 2025.

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