Low‐dose rituximab induction therapy is effective in immunological high‐risk renal transplantation without increasing cytomegalovirus infection

Abstract

To analyze the effect and impact of low-dose rituximab induction therapy on cytomegalovirus infection in living-donor renal transplantation. Methods: A total of 92 recipients undergoing living-donor renal transplantation at Okayama University Hospital from May 2009 to August 2018 were evaluated retrospectively. Indications for preoperative rituximab (200 mg/body) were the following: (i) ABO major mismatch; (ii) ABO minor mismatch; (iii) donor-specific anti-human leukocyte antigen antibody-positive; and (iv) focal segmental glomerulosclerosis. We excluded four recipients who were followed <3 months, five who received >200 mg/ body rituximab and seven who received prophylactic therapy for cytomegalovirus. Results: There were 59 patients in the rituximab group and 17 in the non-rituximab group. Groups differed significantly in age (median age 53 vs 37 years, respectively; P = 0.04), but not in sex (male 64% vs 65%, P = 1.00), focal segmental glomerulosclerosis (3% vs 0%, P = 1.00) or percentage of cytomegalovirus-seronegative recipients of renal allografts from cytomegalovirus-seropositive donors (12% vs 18%, P = 0.68). The estimated glomerular filtration rate did not differ significantly between groups until 24 months after transplantation. Cytomegalovirus clinical symptoms (10% vs 24%, P = 0.22), including fever ≥38°C (5% vs 12%, P = 0.31) and gastrointestinal symptoms (5% vs 12%, P = 0.31), and the 5-year survival rates of death-censored graft loss (90% vs 83%, P = 0.43) did not differ significantly between groups. Conclusions: Low-dose rituximab induction therapy is effective in immunological highrisk recipients without increasing cytomegalovirus infection in the absence of valganciclovir prophylaxis.

Editorial Comment to Low‐dose rituximab induction therapy is effective in immunological high‐risk renal transplantation without increasing cytomegalovirus infection

“…In terms of neutropenia, the 25% rate of grade 3 neutropenia for the non‐rituximab group in the present study seems higher compared with 1–4% of severe leukopenia observed in prospective trials 1 . The authors consider that it can be attributed to mycophenolate mofetil, and that low‐dose rituximab does not increase the risk of neutropenia, even if used with mycophenolate mofetil.…”

“…In this issue of International Journal of Urology , Yoshinaga et al . reported the clinical outcomes of 59 immunologically high‐risk living‐donor renal transplant recipients who received a dose (200 mg/body) of preoperative rituximab 1 . Immunologically high‐risk patients were defined as having ABO major/minor mismatches, pre‐formed donor‐specific antigen or focal segmental glomerulosclerosis.…”

Seroprevalence of SARS-CoV-2 IgG Antibodies After the Second BNT162b2 mRNA Vaccine in Japanese Kidney Transplant Recipients

“…As KT protocols vary across countries and regions, the vaccine e cacy has not been fully validated in KT recipients in Japan. In Japan, ABO blood-type incompatible (ABOi) KT protocols with strong immunosuppression strategies are necessary due to the absence of donor exchange programs and the serious donor shortage [9][10][11][12][13] . Currently, one-third of the recipients undergo ABOi KT with rituximab desensitization 13 .…”