title: The 5-year outcome of ABO-incompatible kidney transplantation with rituximab induction.
abstract: BACKGROUND
  In 2002, we introduced the anti-CD20 chimeric antibody, rituximab, for ABO-incompatible kidney transplantation (ABO-IKT). Here, we report the 5-year outcome obtained using rituximab as part of the preoperative regimen for ABO-IKT.
  
  
  METHODS
  Between January 2002 and December 2008, 408 patients underwent living-related kidney transplantation at our department. The patients were divided into three groups: group A (n=280), ABO-compatible kidney transplantation (ABO-CKT); group B (n=63), ABO-IKT without rituximab induction; and group C (n=50), ABO-IKT with rituximab induction. Basic immunosuppression was the same in all three groups except for the use of rituximab, which was administered at 100 mg (n=6), 200 mg (n=26), and 500 to 1000 mg (n=18).
  
  
  RESULTS
  The graft survival rates in groups A, B, and C were 99.2%, 96.8%, and 100% at 1 year, 93.8%, 94.9%, and 100% at 3 years, and 88.4%, 90.3%, and 100% at 5 years after transplantation, respectively. Serum creatinine levels in the three groups were not different at 1, 3, and 5 years after transplantation. The numbers of episodes of acute antibody-mediated rejection in groups A, B, and C were 7 (2.5%), 10 (15.9%), and 2 (4.0%), respectively (P=0.651), and acute cellular rejection was observed in 40 (14.3%), 6 (9.5%), and 2 (4.0%) patients, respectively (P=0.0957). There was no increased risk of cytomegalovirus infection in group C.
  
  
  CONCLUSIONS
  In the long term, inclusion of rituximab in the preoperative regimen yielded an even better outcome than that of ABO-CKT and rituximab-untreated ABO-IKT, without any increase in the risk of infection.
authors.affiliation: Department of Surgery, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Fuchinoue
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ishii
authors.forename: Tokihiko
authors.initials: T
authors.lastname: Sawada
authors.forename: Toru
authors.initials: T
authors.lastname: Murakami
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Iwadoh
authors.forename: Akihito
authors.initials: A
authors.lastname: Sannomiya
authors.forename: Ichiro
authors.initials: I
authors.lastname: Koyama
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kubota
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Tojimbara
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakajima
authors.forename: Satoshi
authors.initials: S
authors.lastname: Teraoka
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects / Q000627:therapeutic use*; D001789:Blood Group Antigens; D001787:Blood Group Incompatibility; D003586:Cytomegalovirus Infections / Q000209:etiology; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007564:Japan; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D000069283:Rituximab; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D001789:Blood Group Antigens; D007166:Immunosuppressive Agents; D000069283:Rituximab