Fixed-Dose Rituximab for Pre-Transplant DSA in Kidney Transplant Recipients
1Transplant, Barnes-Jewish Hospital, St. Louis, MO, 2SSM Health Saint Louis University Hospital, Saint Louis, MO, 3Barnes-Jewish Hospital, Edwardsville, IL, 4Pharmacy, University of Michigan, Ann Arbor, MI, 5Pharmacy, Barnes-Jewish Hospital, Saint Louis, MO, 6Washington University, Saint Louis, MO, 7Barnes-Jewish Hospital, St. Louis, MO, 8Washington University, St Louis, MO, 9Transplant, Washington University, St. Louis, MO
Meeting: 2022 American Transplant Congress
Abstract number: 1385
Keywords: HLA antibodies, Induction therapy, Kidney transplantation, Monoclonal antibodies
Topic: Clinical Science » Kidney » 37 - Kidney Immunosuppression: Induction Therapy
Session Information
Session Name: Kidney Immunosuppression: Induction Therapy
Session Type: Poster Abstract
Date: Monday, June 6, 2022
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
Session Information
Session Time: 5:30pm-7:00pm
Presentation Time: 5:30pm-7:00pm
Location: Hynes Hall C
*Purpose: Donor specific antibodies (DSAs) occur in 15-30% of kidney transplant recipients (KTRs) and are associated with rejection and graft loss. Rituximab (RTX), an antiCD20 monoclonal antibody, has been used for treatment of DSA in the setting of antibody mediated rejection (ABMR) and explored for positive crossmatch (XM). No current studies have explored the use of fixed-dose RTX only for DSA at transplant in addition to standard depleting induction. Our objective is to assess safety and efficacy of RTX 200 mg in KTRs for presence of DSA at transplant.
*Methods: This was a retrospective analysis of adult KTRs with DSA at transplant from 2010-2020. Exclusion criteria included multi-organ transplant, ABO incompatibility, and non-depleting induction. Patients were divided into two groups based on non-protocolized use of RTX within 30 days of transplant. Primary outcome was biopsy proven ABMR within 1-year post-transplant. Other outcomes were DSA clearance and de novo development of class I and II DSA. Safety outcomes included development of CMV or BKV DNAemia within 1-year post-transplant.
*Results: A total of 192 eligible patients were included. Groups were well matched with differences only in positive flow XM at transplant (Table 1). ABMR was 5.6% in the RTX group vs 4% (p=0.65). There was no difference in clearance of class I or II DSA (Table 2). Development of de novo DSA was lower in the RTX group driven by class II DSA (11.4% vs 33.3%, p=0.03). BKV DNAemia was similar between groups. There was a higher incidence of CMV DNAemia in the RTX group 16.4% vs 4% (p=0.03).
Table 1
| RTX (n=142) | No RTX (n=50) | p-value | |
| Male (n, %) | 67 (47.2) | 29 (58) | 0.19 |
| Age (mean, SD) | 53.9±12.9 | 51.5±13.3 | 0.26 |
| Black race (n, %) | 61 (42.9) | 17 (34) | 0.13 |
| Deceased donor (n, %) | 125 (88) | 47 (94) | 0.29 |
| Class I CPRA (median, IQR) | 4 [0-25.9] | 4 [0-35] | 0.59 |
| Class II CPRA (median, IQR) | 3 [0-30.3] | 3.5 [0-20.3] | 0.88 |
| HLA mismatches (mean, SD) | 4.1±1.4 | 3.6±1.9 | 0.06 |
| Positive Flow XM (n, %) | 59 (41.5) | 9 (18) | 0.03 |
| Class I DSA at transplant (n, %) | 65 (45.8) | 20 (40) | 0.48 |
| Class II DSA at transplant (n, %) | 91 (64.1) | 33 (66) | 0.81 |
Table 2
| RTX (n=142) | No RTX (n=50) | p-value | |
| Clearance of any DSA (n, %) | 55/83 (66.3) | 9/15 (60) | 0.64 |
| Clearance DSA Class I (n, %) | 27/45 (60) | 3/4 (75) | 0.55 |
| Clearance DSA Class II (n, %) | 37/60 (61.7) | 6/12 (50%) | 0.45 |
| Any De novo DSA (n, %) | 17/88 (19.3) | 7/15 (46.7) | 0.02 |
| De novo DSA Class I (n, %) | 7/88 (8) | 3/15 (20) | 0.15 |
| De novo DSA Class II (n, %) | 10/88 (11.4) | 5/15 (33.3) | 0.03 |
| ABMR (n, %) | 8 (5.6) | 2 (4) | 0.65 |
| BKV DNAemia (n, %) | 26 (18.4) | 13 (26.0) | 0.25 |
| CMV DNAemia (n, %) | 23 (16.2) | 2 (4) | 0.03 |
*outcomes at 1-year
*Conclusions: Fixed-dose RTX did not improve clearance of DSA or ABMR but did demonstrate a decrease in de novo class II DSA, and higher risk of CMV DNAemia.
To cite this abstract in AMA style:
Progar K, Kurwicki K, Nesselhauf N, Hagopian J, January S, Wijeweera H, McCloskey M, Merzkani M, Santos RDelos. Fixed-Dose Rituximab for Pre-Transplant DSA in Kidney Transplant Recipients [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/fixed-dose-rituximab-for-pre-transplant-dsa-in-kidney-transplant-recipients/. Accessed May 16, 2025.« Back to 2022 American Transplant Congress