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Kidney Week

Abstract: PO2573

Effect of Rituximab Dose on Induction Therapy in ABO-Incompatible Living Kidney Transplantation: A Network Meta-Analysis

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical


  • Hwang, Seon Deok, Inha University, Incheon, Incheon, Korea (the Republic of)
  • Song, Joon Ho, Inha University, Incheon, Incheon, Korea (the Republic of)
  • Kim, Kipyo, Inha University, Incheon, Incheon, Korea (the Republic of)
  • Park, Woo Yeong, Keimyung University Dongsan Medical Center, Daegu, Korea (the Republic of)
  • Lee, Seoung woo, Inha University, Incheon, Incheon, Korea (the Republic of)

Rituximab is an induction immunosuppressant essential for ABO-incompatible kidney transplantation, but studies on its dosing, which differs between countries and transplant centers, are lacking we retrospectively investigated this phenomenon


we retrospectively investigated this phenomenon by including five groups: ABO compatible; placebo; and rituximab 200 mg, 200–500 mg, and 500 mg. Publications were retrieved using CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded databases from 1970 to February 2020 and analyzed. Reviews, observational studies, and clinical trials with unclearly defined outcomes or omitted graft failure as an outcome were excluded. We performed direct and indirect network meta-analyses using Bayesian models and ranked different rituximab doses using generation mixed treatment comparison. The GRADE of network meta-analysis approach specified four levels of certainty for a given result: high, moderate, low, and very low. The outcomes were patient survival, graft failure, and infections including bacterial and viral.


Twenty-one trials with 4,256 subjects were analyzed for glomerular filtration rates, graft loss, antibody-mediated rejection, T-cell mediated rejection, fungal infection (Candida), and patient survival rates, which did not differ among four groups. However, incidence of sepsis and cytomegalovirus infection (0.728 and 0.855, 95% confidence interval: 0.572–0.926 and 0.724–0.921, respectively) were significantly lower in rituximab 200-mg group than in other groups.


In conclusion, in ABO-incompatible kidney transplantation, low-dose rituximab is more efficacious than higher doses and reduces serious infection risks. Future studies of large-scale, long-term data and further discussions on using lower rituximab doses are necessary.