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Kidney Week

Abstract: PO2577

Single-Dose Rituximab and Antithymocyte Globulin (ATG) in Hypersensitized Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Wang, Aileen, Stanford University School of Medicine, Stanford, California, United States
  • Wang, Uerica K., Stanford University School of Medicine, Stanford, California, United States
  • Troxell, Megan L., Stanford University School of Medicine, Stanford, California, United States
  • Busque, Stephan, Stanford University School of Medicine, Stanford, California, United States
  • Lenihan, Colin R., Stanford University School of Medicine, Stanford, California, United States
Background

Hypersensitized kidney transplant recipients (calculated panel reactive antibody (cPRA) ≥ 98%), may represent a population at high risk of posttransplant immunologic events. Their optimal induction regimen so far remain uncertain. The goal of this study was to compare 1-year outcomes of patients receiving rituximab and ATG as induction, the majority of whom were hypersensitized, with highly sensitized recipients (cPRA ≥ 80%) who received ATG alone.

Methods

All patients ≥ 18 years received a flow cross-match compatible kidney transplant between December 2014 and May 2020. We excluded patients who underwent pretransplant desensitization, simultaneous multi-organ transplantation, or received 0-HLA antigen mismatched organ. The exposure of interest was receipt of single dose rituximab (500mg) at induction. The 1-year outcomes were 1) patient and death censored graft survival, 2) glomerular filtration rate (GFR), 3) de novo DSA formation, 4) biopsy proven T-cell or antibody mediated rejection, 5) the composite of dnDSA and rejection, 6) BK viremia, and 7) CMV viremia.

Results

70 patients received rituximab and ATG (Ritux) and 39 received ATG alone (Control). The Ritux group were (numerically) younger, more sensitized, received kidneys with a longer cold ischemia time, and lower kidney donor profile index. ATG doses were similar. The majority were deceased donor transplants. 1-year patient and death censored graft survival, mean GFR, incidences of BK viremia and CMV viremia were similar for Ritux and Control. 2 patients with primary graft non-function (1 in each group) and 1 patient with early posttransplant death (in Ritux) were excluded from the remaining outcome analyses (Table 1).

Conclusion

The addition of rituximab to ATG as induction for hypersensitized patients appear to be safe and is associated with excellent 1-year outcomes in patient and death cenosred graft survival. Rituximab at induction was associated with reduced incidence of dnDSA formation and/or rejection at 1-year post transplant. Our observations warrant further evaluatoin of anti-B cell therapy induction for hypersensitized kidney transplant recipients.

Table 1
1-Year OutcomesRitux (n=68)Control (n=38)P Value
Rejection5 (7.0%)6 (15.8%)0.20
De Novo DSA5 (7.3%)7 (18.4%)0.11
De Novo DSA and/or Rejection9 (13.2%)12 (31.6%)0.04