Cost-saving induction immunosuppressive protocol in mild-to-moderate immunological risk renal transplantation

Abstract

Background Conventional induction immunosuppression is cost intensive in developing countries. We evaluated the role of low-dose rituximab (100 mg) with or without low-dose antithymocyte globulin (ATG) as an induction agent in moderate and mild immunologic risk renal transplantation, respectively. Patients and methods Of the 34 patients who underwent renal transplantation, 17 with mild immunological risk received induction with 100 mg of rituximab, and 17 with moderately increased immunological risk received an additional 1 mg/kg of ATG (group A). They were compared with 34 immunological risk-matched historic controls (group B), who did not receive any induction in mild immunological risk and 1 mg/kg of ATG alone with moderately increased immunological risk with regard to the incidence and type of biopsy-proven acute rejections, estimated glomerular filtration rate (eGFR), and infection rates at the end of 1 year after transplantation. Results Two (5.9%) patients in group A had biopsy-proven acute rejection during the first year compared with six (17.6%) in group B (P=0.047). None had antibody-mediated rejection in group A compared with two (5.9%) in group B (P=0.103). At 1 year, eGFR between group A and group B was 72.42 ± 15.02 and 67.97 ± 14.48 ml/min, respectively (P=0.25). Major infection episodes were noted in 18 (52.9%) and 20 (58.8%) in group A and group B, respectively (P=0.62). Conclusions Low-dose rituximab with or without low-dose ATG reduced overall biopsy-proven acute rejection in mild and moderate kidney transplant patients with comparable eGFR, and infection episodes at the end of 1 year and can be considered a cost-effective induction immunosuppressive protocol.