Induction Immunosuppressive Therapies in Renal Transplantation

Steven Gabardi, Pharm.D., BCPS; Spencer T. Martin, Pharm.D., BCPS; Keri L. Roberts, Pharm.D.; Monica Grafals, M.D.


Am J Health Syst Pharm. 2011;68(3):211-218. 

In This Article

Future Approach: Rituximab

Rituximab is an anti-CD20, humanized, monoclonal antibody labeled for use in CD20-positive non-Hodgkin's lymphoma, chronic lymphoid leukemia, and rheumatoid arthritis. CD20 is a surface antigen expressed on all circulating, mature B cells. There has been a recent shift in focus on B cells and their ability to trigger antibody-mediated rejection and contribute to acute cellular rejection due to their ability to act as antigen-presenting cells. The ability of rituximab to deplete a patient of circulating mature B cells led Tyden and colleagues[50] to test the use of rituximab as a single-dose induction agent in patients receiving a renal transplant from a living donor in a prospective, randomized, double-blind, placebo-controlled, multi-center study. All patients received 375 mg/m2 of rituximab or placebo in conjunction with tacrolimus, mycophenolate mofetil, and a corticosteroid tapered regimen for immunosuppressive maintenance therapy. A total of 68 patients were included in each group and followed for six months to determine if there was a difference in the composite endpoint of treatment failure, defined as BPAR, graft loss, or death within six months. The composite endpoint did not differ between the treatment and control groups (10 patients versus 14 patients, p = 0.348), with no difference seen in the occurrence of BPAR alone (8 patients in the rituximab group versus 12 patients in the control group, p = 0.317). The rates of bacterial infection, leukopenia, and anemia were similar between groups. At this time, the use of rituximab as an induction agent alone for renal transplantation is questionable, especially because these data show no benefit versus placebo. An overview of immunosuppressive agents appears in Table 1.


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