The effect of rituximab dose on infectious complications in ABO-incompatible kidney transplantation

Juhan Lee, Jae Geun Lee, Sinyoung Kim, Seung Hwan Song, Beom Seok Kim, Hyun Ok Kim, Myoung Soo Kim, Soon Il Kim, Yu Seun Kim, Kyu Ha Huh

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44 Scopus citations


Background Rituximab (RIT) improves the outcomes of ABO-incompatible (ABOi) kidney transplantation (KT), but it has been associated with infectious complications. The aim of this study was to investigate infectious complications according to the dose of RIT in ABOi KT. MethodsWe analyzed 213 recipients [118 ABO-compatible (ABOc) KT and 95 ABOi KT] who underwent living donor KT between 2010 and 2014. ABOi KT patients were categorized by RIT dose: standard RIT (375 mg/m2, n = 76) versus reduced RIT (200 mg, n = 19). All patients received basiliximab and maintained on triple immunosuppression consisting of tacrolimus, prednisone and mycophenolate mofetil. Infectious complications and post-transplant outcomes were analyzed for 1 year following KT. ResultsThe rates of overall infectious complications among the three groups were comparable (22.9% in ABOc KT, 38.2% in standard RIT and 26.3% in reduced RIT, P = 0.069). In the standard RIT group, hepatitis B virus reactivation occurred in three recipients (3.9%) with hepatitis B surface antigen[-]/anti-hepatitis B core antibody[+]. Three cases (3.9%) of Pneumocystis jirovecii pneumonia occurred in the standard RIT group. Serious infections developed in 13 of the ABOc KT (11.0%), 20 from the standard RIT group (26.3%) and 2 from the reduced RIT group (10.5%, P = 0.015). Standard-dose RIT was found to be an independent risk factor for serious infections [hazard ratio: 2.59 (95% confidence interval: 1.33-5.07), P = 0.005]. There were no significant differences in rejection, renal function, graft survival and patient survival between standard and reduced RIT groups. ConclusionsStandard RIT increased the risk of serious infection when compared with reduced-dose RIT. Reduced-dose RIT might be sufficient for ABOi KT without increasing the risk of serious infection.

Original languageEnglish
Pages (from-to)1013-1021
Number of pages9
JournalNephrology Dialysis Transplantation
Issue number6
StatePublished - 24 Jun 2016

Bibliographical note

Publisher Copyright:
© 2016 The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.


  • ABO incompatibility
  • desensitization
  • infection
  • kidney transplantation
  • rituximab


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