We evaluated the efficacy and safety of
rituximab as induction
therapy in renal transplant patients. In a double-blind, placebo-controlled study, 280 adult renal transplant patients were randomized between a single dose of
rituximab (375 mg/m(2)) or placebo during transplant surgery. Patients were stratified according to panel-reactive antibody (PRA) value and rank number of
transplantation. Maintenance immunosuppression consisted of
tacrolimus,
mycophenolate mofetil and
steroids. The primary endpoint was the incidence of biopsy proven acute rejection (BPAR) within 6 months after
transplantation. The incidence of BPAR was comparable between
rituximab-treated (23/138, 16.7%) and placebo-treated patients (30/142, 21.2%, p = 0.25). Immunologically high-risk patients (PRA >6% or re-transplant) not receiving
rituximab had a significantly higher incidence of rejection (13/34, 38.2%) compared to other treatment groups (
rituximab-treated immunologically high-risk patients, and
rituximab- or placebo-treated immunologically low-risk (PRA ≤ 6% or first transplant) patients (17.9%, 16.4% and 15.7%, p = 0.004).
Neutropenia (<1.5 × 10(9) /L) occurred more frequently in
rituximab-treated patients (24.3% vs. 2.2%, p < 0.001). After 24 months, the cumulative incidence of
infections and
malignancies was comparable. A single dose of
rituximab as induction
therapy did not reduce the overall incidence of BPAR, but might be beneficial in immunologically high-risk patients. Treatment with
rituximab was safe.