Effect of Pretransplant Rituximab Use on Posttransplant Clinical Outcomes in Patients with High Panel Reactive Antibody Scores

Abstract

Background/Aims: Whether desensitization treatment is needed before kidney transplant (KT) in patients with high panel reactive antibody (PRA) scores but negative cross-matching (XM) tests remains controversial. This study aimed to investigate the effect of pretransplant rituximab (RTX) treatment on clinical outcomes in these patients. Methods: The study included 52 patients with PRA >50% but negative XM tests before transplantation. A single dose of RTX was administered before KT in 32 patients (RTX group). The 20 patients without RTX treatment were considered as controls (CON group). We compared the development of acute antibody-mediated rejection (AMR), rejection-free survival, allograft function, allograft and patients' survival rates and infection rates between the 2 groups. Results: The rate of acute AMR development was significantly lower in the RTX group than in the CON group (p = 0.009), and rejection-free survival in the RTX group was higher than in the CON group (p = 0.042). The 3-year graft and patient survival rates were higher in the RTX group than in the CON group (p = 0.007 and p = 0.037, respectively). There were no significant differences in infection rates between the groups. Conclusions: Pretransplant use of RTX improved the post-transplant clinical outcomes in patients with high PRAs but negative XM tests.

Desensitization: Overcoming the Immunologic Barriers to Transplantation

“…3-year patient and graft survival were 95% and 90%, respectively, and acute rejection was diagnosed in 4 patients (14%) during the follow-up period. In a Korean study by Hwang et al [31], patients with high panel reactive antibody (PRA scores) but negative crossmatch who received pretransplant rituximab ( n = 32) had significantly lower risk of ABMR and higher 3-year graft and patient survival rates ( P = 0.007 and P = 0.037, resp. ).…”

Impact of delayed graft function on clinical outcomes in highly sensitized patients after deceased-donor kidney transplantation

“…In this study, we included 709 cases of DDKT who received kidneys from 614 deceased donors (DDs) at three transplant centers (Seoul St. Mary’s Hospital, Keimyung University Dongsan Medical Center, and Uijeongbu St. Mary’s Hospital) between October 2005 and December 2018. In all kidney transplant recipients (KTRs), the panel reactive antibody (PRA) level was measured via enzyme-linked immunosorbent assay (ELISA, LAT-M; One-Lambda Inc., Los Angeles, CA, USA) or the Luminex method (LIFECODES Life Screen Deluxe; Gen-Probe Inc., San Diego, CA, USA) as described previously before KT [ 15 ].…”

“…In living-donor KT (LDKT), desensitization therapy has been shown to improve short-term and long-term prognosis after KT in highly sensitized patients because LDKT ensures sufficient time for desensitization [ 13 , 14 ]. However, in DDKT, procedures that require a lot of time and preparation, such as plasmapheresis, are difficult to perform before transplantation, and only rituximab (RTX), a B-cell depleting agent can be used for desensitization in DDKT [ 15 , 16 ]. Therefore, it is possible that many cases of DDKT may progress without enough removal of anti-HLA antibody.…”

Kidney transplantation in highly sensitized recipients

“…3B ) [ 64 ]. In the case of PRA ≥ 50% alone (with crossmatch-negative and DSA MFI titer < 3,000), only rituximab is administered 7 days before transplantation without plasmapheresis [ 65 ].…”