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

• Published in: Scientific reports 2019-11, Vol.9 (1), p.16475-8, Article 16475
• Main Authors: Kim, Deok Gie, Lee, Juhan, Seo, Won Jun, Lee, Jae Geun, Kim, Beom Seok, Kim, Myoung Soo, Kim, Soon Il, Kim, Yu Seun, Huh, Kyu Ha
• Format: Article
• Language: English
• Subjects: 692/4019/592/75; 692/4022/272/1684; ABO system; Arteriosclerosis; Atherosclerosis; Atherosclerosis - drug therapy; Atherosclerosis - etiology; Atherosclerosis - pathology; Beta cells; Blood Group Incompatibility; Blood groups; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - drug therapy; Cardiovascular Diseases - etiology; Cardiovascular Diseases - pathology; Desensitization, Immunologic - mortality; Diabetes mellitus; Dialysis; Female; Follow-Up Studies; Health risk assessment; Histocompatibility testing; Humanities and Social Sciences; Humans; Immunologic Factors - therapeutic use; Immunotherapy; Kidney transplantation; Kidney Transplantation - adverse effects; Kidney transplants; Male; Middle Aged; Monoclonal antibodies; multidisciplinary; Prognosis; Retrospective Studies; Rituximab; Rituximab - therapeutic use; Science; Science (multidisciplinary); Survival Rate
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-019-52942-8

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.