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Sci Rep. 2019 Nov 11;9(1):16475. doi: 10.1038/s41598-019-52942-8.

Rituximab protects against development of atherosclerotic cardiovascular disease after kidney transplantation: a propensity-matched study.

Kim DG1, Lee J2, Seo WJ3, Lee JG2, Kim BS4,5, Kim MS2,5, Kim SI2,5, Kim YS2,5, Huh KH6,7.

Author information

1
Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
2
Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
3
Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea.
4
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
5
The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea.
6
Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea. khhuh@yuhs.ac.
7
The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea. khhuh@yuhs.ac.

Abstract

Recent studies have implicated B cells in atherosclerosis and have verified the atheroprotective effect of rituximab. Rituximab is widely used for desensitization in ABO-incompatible or crossmatch-positive kidney transplantation (KT). Using a single-center KT database, we performed propensity-matched analysis to investigate the association between rituximab and posttransplant atherosclerotic cardiovascular disease (ASCVD). Among 1299 eligible patients, 239 given rituximab induction were matched with 401 controls in a 1:2 propensity score matching process. The cumulative rate of ASCVD during 8 years of follow-up was significantly lower in rituximab-treated patients, compared with matched controls (3.7% vs. 11.2%; P = 0.012). However, all-cause mortality did not differ by group (2.9% vs. 4%; P = 0.943). In multivariable Cox analysis, rituximab proved independently protective of ASCVD (hazard ratio = 0.34, 95% confidence interval: 0.14-0.83). The lower risk of ASCVD seen with rituximab induction reached significance only in patient subsets of diabetes mellitus, pretransplant dialysis, or older age (>50 years). Rituximab induction confers a lower risk of ASCVD during the posttransplant period. This atheroprotective effect appears particularly beneficial in patients whose risk of ASCVD is heightened.

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