Background: In our department, 313 recipients underwent transplantations using a low-dose (150 mg/m2) rituximab protocol between 2005 and 2012. After the introductory period for this protocol, a few reports describing the incidences of rejection and adverse events were made.
Materials and Methods: The subjects in this study included 313 recipients treated with low-dose rituximab and 266 recipients without rituximab treatment. Low-dose rituximab was administered 5 to 7 days before transplantation in combination with other antibody-depleting therapies, such as plasmapheresis. We examined the incidences of rejection during the early (within 1 year) and late (within 4 years) phases as well as the adverse events, such as neutropenia and viral infection, in each group.
Results: The incidence of acute rejection was 17.5% among recipients without rituximab treatment and 10% among recipients with rituximab treatment (P < 0.05). The incidence of chronic rejection was 4.5% among recipients without rituximab treatment and 0.6% among recipients with rituximab treatment (P < 0.05). The appearance of de novo anti-HLA antibodies after transplantation was lower among recipients with rituximab treatment than among recipients without rituximab treatment (9% vs. 3%). Most of the de novo antibodies belonged to Class 2, regardless of the use of rituximab treatment. The use of additional anti-rejection therapy, such as steroid pulse administration, was more common among recipients without rituximab treatment than among recipients with rituximab treatment. Therefore, postoperative complications, such as hypertension, hyperlipidemia, CMV antigenemia and PTDM, were more common among recipients without rituximab treatment than among recipients with rituximab treatment. Neutropenia was observed in significantly more recipients with rituximab treatment until 4 years after transplantation. At 4 years after transplantation, no difference in the lymphocyte population was detected between the two groups using flow cytometry. Conclusion: Low-dose rituximab therapy is a safe and effective treatment for immunological high-risk transplantations. Rituximab suppresses cellular as well as humoral immunological activities, leading to a reduced rate of rejection and a reduced need for additional anti-rejection treatments during the early and late post-treatment phases.
To cite this abstract in AMA style:Hirai T, Ishida H, Omoto K, Nozaki T, Shimizu T, Furusawa M, Tanabe K. Evaluation of Low-Dose Rituximab Treatment; the Incidence of Graft Rejection and Adverse Events in 313 Living Kidney Transplant Recipients [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/evaluation-of-low-dose-rituximab-treatment-the-incidence-of-graft-rejection-and-adverse-events-in-313-living-kidney-transplant-recipients/. Accessed April 18, 2021.
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