BACKGROUND: The long-term effect of rituximab (RIT) and splenectomy (SPX) on de novo HLA Ab production after renal transplantation (RTx) was unclear. METHODS: We examined 320 consecutive transplants including 228 ABO-identical/compatible RTx (ABO-Id/C) and 92 ABO-incompatible RTx (ABO-In) during 2005 to 2009 were examined for de novo HLA antibody production and graft outcome. Among 92 ABO-In, 30 and 51 were treated with rituximab and splenectomy, respectively. We generated Kaplan-Meier survival curves and analysed for correration using Chi-square for independence test. RESULTS: Death-uncensored 5-year graft survivals were 98.1% in ABO-Id/C and 90.9% in ABO-In. Three-year graft survival of RIT-treated patients was 96.7%. Five-year graft survival of splenecomized patients was 87.6%. Graft survival in ABO-Id/C was significantly higher than ABO-In, RIT-treated or post-SPX patients. Only 3 developed clinical CAMR. De novo HLA Ab including DSA and non-DSA were detected in 13.3%. Most of DSA were directed to class II. In contrast, a majority of non-DSA was directed to class I. Rates of de novo HLA Ab in ABO-Id/C and ABO-In were 13.9% and 11.7%, respectively. De novo HLA Abs were produced in 13.8% of CSA-, 12.0% of TAC-, 13.0% of MMF- and 19.0% of MZR-treated recipients. However, renal function remained stable even in recipients with de novo HLA Ab (eGFR: 47.2+/-16.3). CONCLUSIONS: We obtained excellent graft outcome in living donor RTx, whereas graft survival of ABO-In was somewhat lower than that of ABO-Id/C. Neither pre-transplant RIT nor SPX treatment seemed to have an inhibitory effect on de novo HLA antibody production.

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