Background. Kidney transplant recipients with donor-specific human leukocyte antigen-antibodies (HLA-DSA) are at increased risk of acute antibody-mediated rejection (AAMR) and graft loss. However, data on the incidence of early AAMR using rituximab without intravenous immunoglobulin are currently lacking.
Methods. Between 2009 and 2011, we performed 221 kidney transplantations. Pre-transplant T-cell complement dependent cytotoxicity cross-matches (CDC-XM) were negative in all cases, while screening flow panel reactive antibodies were positive in 43. Patients were classified into three groups: Group A (n=27), HLA-DSA positive; Group B (n=16), non-DSA HLA-antibody positive; Group C (n=178), HLA-antibody negative. Each patient received a single fixed low dose of rituximab (100 mg) with double filtration plasmapheresis as an induction protocol for HLA-DSA positive kidney transplantation.
Results. The proportions of patients without AAMR in Groups A, B, and C were 73.2%, 100%, and 95.9% at 1 year, and 73.2%, 100%, and 91.4% at 2.5 years after transplantation, respectively (p<0.001). Seven of 27 HLA-DSA positive cases (25.9%) developed AAMR, and 2 suffered graft loss. Cox multivariate analysis showed that the significant risk factors for AAMR were a history of transplantation (odds ratio: 78.27, p=0.007) and the presence of HLA-DSA (odds ratio: 6.21, p=0.018). Graft survival rates in Groups A, B, and C were 92.1%, 100%, and 98.3% at 1 year, and 87.8%, 100%, and 96.0% at 2.5 years, respectively (p=0.022).
Conclusions. Fixed low-dose rituximab induction therapy was safe and effective for reducing AAMR and graft loss in sensitized patients. However, HLA-DSA was still strongly associated with AAMR episodes and 2.5-year graft survival.
To cite this abstract in AMA style:Tomita Y, Iwadoh K, Nakajima I, Fuchinoue S, Koyama I. Single Fixed Low Dose of Rituximab as Induction Therapy for Kidney Transplant Recipients Highly Sensitized with Donor-Specific Antibodies [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/single-fixed-low-dose-of-rituximab-as-induction-therapy-for-kidney-transplant-recipients-highly-sensitized-with-donor-specific-antibodies/. Accessed May 17, 2021.
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