Korean J Transplant.  2023 Nov;37(Suppl 1):S159. 10.4285/ATW2023.F-7449.

Rituximab induction therapy in deceased donor kidney transplantation: a case series analysis

• Kim HD
• Ban TH
• Hwang I
• Choi BS
• Kim BS
• Park M
• Park DJ
• Lim J
• Kim MH
• Hwang JK

• KMID: 2551779
• DOI: http://doi.org/10.4285/ATW2023.F-7449

Abstract

Background
This retrospective observational study presents a case series involving deceased donor kidney transplant (DDKT) recipients who received rituximab induction therapy, aiming to assess the impact of rituximab.
Methods
Among the 33 patients in this study, basiliximab was used as induction immunosuppression in all cases. Maintenance immunosuppression consisted of a triple regimen involving tacrolimus, mycophenolic acid, and steroids. Among the patients, five individuals received rituximab on the day of transplantation (RTX group). Rituximab was administered intravenously at a dose of 375 mg per square meter of body surface area over a 4-hour period before transplant.
Results
In the RTX group, the average panel-reactive antibody values were significantly higher at 76.8% for class I and 80.0% for class II, compared to the control groups 3.5% and 4.2%, respectively. Acute rejection occurred in 40% of the RTX group and 32.1% of the control group, with antibody-mediated rejection observed in 20% and 3.6%, respectively, showing no significant difference between the groups. The average estimated glomerular filtration rate at 6 months posttransplant was 51.8 mL/min in the RTX group and 68.1 mL/min in the control group, with no statistically significant difference. Cytomegalovirus and BK virus viremia were reported in 60% and 40% of the RTX group, and in 53.6% and 14.3% of the control group, respectively, with no significant difference. Incidences of coronavirus disease 2019 infection or bacterial infections leading to hospitalization did not differ significantly between the two groups. Notably, there were no cases of graft failure in either group.
Conclusions
This case series study indicates that highly sensitized DDKT recipients who received rituximab induction therapy exhibited comparable rates of acute rejection, renal function, infections, and graft survival to those in the control group. However, larger-scale studies are required to confirm the efficacy of rituximab as an induction therapy in highly sensitized DDKT candidates.