*Purpose: Recent studies have implicated B cells in atherosclerosis and have verified the atheroprotective effect of rituximab. We sought to explore the effects of rituximab induction on atherosclerotic cardiovascular disease (ASCVD) in the aftermath of KT

*Methods: Using a single-center KT database, we performed propensity-matched analysis to investigate the association between rituximab and posttransplant ASCVD.

*Results: Among 1299 eligible patients, 239 given rituximab induction were matched with 401 controls in a 1:2 propensity score matching process. The cumulative rate of ASCVD during 8 years of follow-upwas significantly lower in rituximab-treated patients, compared with matched controls (3.7% vs. 11.2%; P=0.012). However, all-cause mortality did not differ by group (2.9% vs. 4%; P=0.943). In multivariable Cox analysis, rituximab proved independently protective of ASCVD (hazard ratio [HR]=0.34, 95% confidence interval [CI]: 0.14-0.83). The lower risk of ASCVD seen with rituximab induction reached significance only in patient subsets of diabetes mellitus, pretransplant dialysis, or older age (>50 years).

*Conclusions: Rituximab induction confers a lower risk of ASCVD during the posttransplant period. This atheroprotective effect appears particularly beneficial in patients whose risk of ASCVD is heightened.

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