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Favorable results in ABO ‐incompatible renal transplantation without B cell‐targeted therapy: Advantages and disadvantages of rituximab pretreatment
Author(s) -
Okada Manabu,
Watarai Yoshihiko,
Iwasaki Kenta,
Murotani Kenta,
Futamura Kenta,
Yamamoto Takayuki,
Hiramitsu Takahisa,
Tsujita Makoto,
Goto Norihiko,
Narumi Shunji,
Takeda Asami,
Morozumi Kunio,
Uchida Kazuharu,
Kobayashi Takaaki
Publication year - 2017
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13071
Subject(s) - abo blood group system , medicine , rituximab , transplantation , antibody , immunology , gastroenterology
The effectiveness of desensitization with rituximab in ABO ‐incompatible renal transplantation ( ABO ‐I) has been widely reported. However, ABO ‐I outcomes are still worse than those of ABO ‐identical or ABO ‐compatible renal transplantation ( ABO ‐Id/C). We retrospectively examined the outcomes in consecutive living donor ABO ‐Id/C (n = 412) and ABO ‐I (n = 205) cases to elucidate the causes of inferiority in ABO ‐I. ABO ‐I cases included recipients treated with rituximab ( RIT , n = 131), splenectomy ( SPX , n = 21), or neither because of low anti‐A/B antibody titers (NoR/S, n = 53). Graft survival, infection, and de novo HLA antibody production were compared for ABO ‐I and ABO ‐Id/C, followed by stratification into RIT and NoR/S groups. Propensity score‐based methods were employed to limit selection bias and potential confounders. Overall graft survival for ABO ‐I was significantly lower than that for ABO ‐Id/C (92.8% vs 97.2% after 5 years, P = .0037). Graft loss due to infection with ABO ‐I was significantly more frequent than that with ABO ‐Id/C, whereas acute antibody‐mediated rejection ( AMR ) caused no graft failure in ABO ‐I recipients. Stratified analysis demonstrated significantly higher infection risk with RIT than with NoR/S. Safe reduction or avoidance of rituximab in desensitization protocols might contribute to further improvement of ABO ‐I outcome.