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Abstract: SA-PO480

Rituximab in Antibody Mediated Rejection: Delayed Benefit for Graft Survival?

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational


  • Parajuli, Sandesh, UW Health, Middleton, Wisconsin, United States
  • Mandelbrot, Didier A., U of Wisconsin Hospital, Madison, Wisconsin, United States
  • Muth, Brenda L., University of Wisconsin, Madison, Wisconsin, United States
  • Mohamed, Maha A., University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
  • Redfield, Robert R., University of Wisconsin, Madison, Wisconsin, United States
  • Zhong, Weixiong, University of Wisconsin Madison, Madison, Wisconsin, United States
  • Astor, Brad C., University of Wisconsin, Madison, Wisconsin, United States
  • Djamali, Arjang, School of Medicine and Public Health, Madison, Wisconsin, United States

There is limited information on the role of monitoring biopsies and treatment strategies in late antibody mediated rejection (ABMR) after kidney transplantation.


Seventy-eight patients diagnosed with late ABMR were treated with standard of care (SOC) steroids/IVIG (n=38) ± rituximab (n=40). All patients underwent a follow-up biopsy and DSA monitoring within 3-12 weeks. Patients were followed for 15.9 ± 9.6 months.


Both treatment strategies were associated with a significant decline in DSA, microcirculation inflammation (ptc+g), and C4d Banff scores. In univariate regression analyses, rituximab, eGFR, Banff i, t, v, and chronicity (ci+ct+cv+cg) scores on the first biopsy, and eGFR and Banff v score on the follow-up biopsy were associated with graft loss. Mulltivariate analyses retained only rituximab (HR 0.23, 95% CI 0.06 to 0.84, p=0.03) and eGFR at follow-up biopsy (0.84, 95% CI 0.76 to 0.92, p<0.001) as significant predictors of graft loss. Kaplan-Meier analyses demonstrated that the benefit associated with rituximab was apparent after one year (15% vs. 32% graft loss, p=0.01) (Figure 1).


In conclusion, treatment of late ABMR with steroids/IVIG + rituximab was effective in reducing DSA, microcirculation inflammation, and graft loss. Follow-up biopsies could be considered in the management of acute rejection to monitor the effect of therapy.