Table 3

Relevant paediatric studies on the use of rituximab in kidney transplantation

Role of rituximab inType of studiesCommentaries
Transplantation
Antibody mediated Acute RejectionPaed RCT:

  1. Zarkhin et al 2008(a) (n=20; RTX versus standard-of-care immunosuppression, thymoglobulin and/or pulse steroids) for treatment of biopsy-confirmed acute transplant rejection with B cell infiltrates. Some benefits noted in recovery of graft function (p=0.026) and improvement of biopsy rejection scores at 1-month (p=0.0003) and 6-month (p<0.0001) follow-up biopsies. C4d deposition was not seen on follow-up biopsies after RTX therapy but was seen in 30% of control patients. There was no change in DSA in either group.

Although RTX is used widely in B cell mediated acute rejection, supporting evidence is scarce. Most of the paediatric reports are small case series. Although we have a single paediatric RCT(a) as well as adult case series showing promising results, the larger adult RCT such as the RITUX ERAH study did not show any benefit of adding RTX to the standard plasma exchange, immunoglobulin and corticosteroid at 1 year or 7 years follow-up.(k, l)
Retrospective case series: Kranz et al 2011(b) (n=3), Towmbley et al 2013(c) (n=3) and Gulleroglu et al 2013(d) (n=7).
Prospective cohort/registry analysis: none.
Post-transplantation FSGS recurrencePaed RCT: nonePaediatric evidence is limited to only small case series with conflicting results and reports incidents of serious side effects.
Retrospective case series: Sethna et al 2011(e) (n=4), Grenda et al 2016(f) (n=5), Kumar et al 2012 (g) (n=8) and Dello Strologo et al 2016(h) (n=15).
Prospective cohort/registry analysis: none.
ABOi transplantationRetrospective case series: Hamasaki et al 2019(i) (n=21), Kawamura et al 2020(j) (n=13) and Aikawa et al 2014(k) (n=89).Supplemented primarily by adult series, rituximab has become a standard protocol for ABOi transplantation.

  • Note: (A) RCT’s results have been explained in detail.

  • References (a-l) quoted in table 3 have been elaborated in the online supplemental references.

  • ABOi, ABO incompatible; DSA, donor specific antibody; FSGS, focal and segmental glomerulosclerosis; RCT, randomised control trial; RTX, rituximab.