Introduction: Kidney transplantation is the optimal approach in renal replacement therapy for end-stage renal disease. B cells play a role in rejection in classic T cell-mediated rejection by their ability to act as antigen-presenting cells and T cell activators. The presence of B-cell clusters in renal grafts during acute rejection or the presence of anti-HLA antibodies before transplantation is associated with poorer graft survival. Although the main role of rituximab is to suppress circulating antibodies, additional B cell function will be affected, antigen presentation, and cytokine production. Advancements in multiparameter flow cytometry can give us the phenotype and function of T and B cells to see the response of immunosuppressant drugs. In our study, we plan to see the clinical response in our patients who received Rituximab along with other immunosuppressants. Also, we will see the phenotypic response of Rituximab by measuring CD19, and CD 20 levels. Comparison can be made between variable doses of Rituximab and its response in the form of clinical outcomes and Levels of CD19, and CD20.
Method: Study population: Patients of kidney transplant receiving rituximab in the Department of Nephrology, Jaslok Hospital in the year 2022-2023 after approval from the ethics committee. Inclusion criteria: Patients with the recipient of 1st or 2nd transplant from a living or deceased donor, age above 18 years, single organ transplant only, patient’s giving consent. Exclusion criteria: Identical siblings, Received prior Rituximab, Active infection. Sample size:79 patients. Patients who received Rituximab pre-transplant will be observed for any graft dysfunction, acute rejection, infection, or death till 3 months post-transplant. The patient’s CD19 and CD20 counts were done at 3-5 days,3-6 months of post rituximab dose. These Study Designs: Prospective Observational Study. Study duration: One year recruitment period and 6 months follow-up period.
Results: A total of 79 patients were taken, 47 patients received rituximab while 32 patients did not receive it. Various doses of rituximab were given, a total of 34 patients received 500mg or more of Rituximab while 13 patients received 200mg or less of Rituximab. The average age of the donors was 51 years,76 patients underwent 1st transplant. The average creatinine on discharge was 1.29. 18 patients were Donor-specific antibody positive, and 37 patients were ABOi. Plasmapheresis was done in 39 patients. Follow-up till 6 months was carried out with an average creatinine of 1.5. 20 patients developed infections,19 patients developed acute rejection, and 5 patients died.CD19 and CD20 levels were done before transplant, immediately post-transplant and after 3-6 months, the levels were significantly reduced even after 6 months.
Conclusion: Infections were higher in the Rituximab group. Average CD19 and CD20 levels were seen in low and standard dose Rituximab.