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Published on: April 13, 2021
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ABO Incompatible Kidney Transplantation Without B-cell Depletion is Associated With Increased Early Acute Rejection:
Jonathan M Bleasel1, Susan S Wan1,2, Steven J Chadban1,2,3
1Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Summary
Rituximab is crucial for ABO incompatible kidney transplants (ABOiKT). Omitting this B-cell depleting therapy significantly increased acute rejection and graft loss, highlighting its importance in desensitization protocols.
Area of Science:
- Nephrology
- Transplantation Immunology
- Immunosuppression Therapy
Background:
- ABO incompatible kidney transplantation (ABOiKT) enables more patients to receive transplants.
- Desensitization protocols, often including B-cell depleting therapy like rituximab, are used to mitigate rejection in ABOiKT.
- The necessity of rituximab in modern ABOiKT protocols warrants further investigation.
Purpose of the Study:
- To evaluate the impact of omitting rituximab from desensitization protocols in ABO incompatible kidney transplantation (ABOiKT).
- To compare rejection rates and graft outcomes between rituximab-free ABOiKT, ABOiKT with rituximab, and ABO compatible kidney transplantation (ABOcKT).
Main Methods:
- Retrospective cohort study of 66 consecutive ABOiKT performed without B-cell depleting therapy.
- Comparison with an earlier cohort of 18 ABOiKT performed with rituximab and a contemporaneous cohort of ABO compatible live donor kidney transplants (ABOcKT).
- Analysis of acute rejection rates, antibody-mediated rejection, graft loss, patient survival, and graft survival.
Main Results:
- Rituximab-free ABOiKT showed significantly higher rates of acute rejection within 3 months compared to ABOiKT with rituximab (OR 8.8) and ABOcKT (OR 2.9).
- Six recipients of rituximab-free ABOiKT experienced refractory antibody-mediated rejection requiring splenectomy; two had early graft loss.
- No such severe outcomes were observed in the ABOiKT with rituximab or ABOcKT groups.
- Patient and graft survival rates were similar across all groups over a median follow-up of 3.1 years.
Conclusions:
- Omitting rituximab from ABO incompatible kidney transplant desensitization protocols is associated with a substantial increase in acute rejection and refractory antibody-mediated rejection.
- These findings support the continued use of rituximab in ABOiKT protocols to improve early graft outcomes.
- Rituximab remains a critical component for successful ABO incompatible kidney transplantation.
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