Outcomes of dual induction therapy in renal transplant

Background: Rituximab is a chimeric anti CD 20 monoclonal antibody that leads to B cell depletion. Its successful use in ABO-incompatible renal transplant recipients has resulted in comparable or even better 10 year survival. T cell induction is routinely used and has significantly reduced the number and severity of acute cellular rejection episodes in renal transplantation. Does adding rituximab induction to T cell induction further improve outcome of renal transplants. Aim of the study: To evaluate the effectiveness of Rituximab and T cell induction agent (rATG or Basiliximab) in renal transplant recipients. Methods: 161 patients who underwent renal transplant between 27th August 2013 to 1st April 2016 were part of this retrospective analysis. 48 patients who did not receive any induction agent were excluded. Of the remaining 113 patients; 72 received Rituximab & rATG (group A) while 41 received Rituximab & Basiliximab (group B). Maintenance immunosuppressive regimen consisted of Tacrolimus; Mycophenolate sodium and Corticosteroids. Data was analyzed using descriptive statistics; mean and standard deviation (SD) for continuous variables and frequency and percentages for categorical variables. Patient and graft survival was calculated as per Kaplan-Mier analysis. Chi-square test was used to compare the outcome of two groups. A p value of <0.05 was considered statistically significant. Results: There was no significant difference in age; sex; etiology of CKD and HLA Mismatches in the two groups. In groupAthere was a significantly lower incidence of ACR (11.1% vs 17%) & AMR (1.3 vs 7.3%) (p = <0.01). However; a higher incidence of late onset neutropenia; and invasive fungal infections was observed. The patient & graft survival at 24 months in group A was 90.6% & 94.7% and in group B it was 96.1% % 96.1% respectively. Conclusions: Rituximab in addition to rATG as induction; was associated with a lower incidence of ACR & AMR as compared to Rituximab & Basiliximab induction regimen. However it was associated with higher incidence of late onset neutropenia resulting in severe fatal infections & lower patient survival.