Table 2.
Characteristics of included studies evaluating the outcomes of preemptive rituximab
|
Ref.
|
Country
|
Design
|
n
(%)
|
Population
|
Age
|
Rituximab dose and protocol
|
Concurrent PP
|
Def of recurrence
|
Recurrence
|
Graft survival
|
Follow-up duration
|
Quality assessment
|
| Burke et al[22], 2009 | United States | Retrospective | 29 | FSGS undergoing KT | Age at KT: 6-21 yr | N/A | No | New onset proteinuria | 6/18 (33%) vs 8/11 (72%) | No significant difference in graft survival | N/A | Fair, 3-1-2 |
| Sagheshima et al[23], 2010 | United States | Prospective | 40 | FSGS undergoing KT | Age at KT: 4-24 yr | N/A | No | UPCR > 3.5 post-transplant | 8/29 (28%) vs 7/11 (64%) | N/A | N/A | Low, 3-1-1 |
| Fornoni et al[24], 2011 | United States | Retrospective | 41 | High-risk pediatric/young adult FSGS undergoing KT: (< 25 yr at FSGS Dx or progression to ESKD within 7 yr) | Age at KT: 15 ± 5.5 yr (rituximab), 12.3 ± 5.2 yr (control) | One dose of rituximab (375 mg/m2) within 24 h of kidney transplantation | No | UPCR > 3.5 within 30 d post-transplant or need for PP. Protocol biopsy in 20/27 (74%) | 7/27 (26%) vs 9/14 (64%) | 1-yr graft survival: 95.8% vs 85.7% (P = 0.26) | N/A | High, 4-1-3 |
| Miyauchi et al[25], 2011 | Japan | Prospective | 25 | FSGS undergoing KT | N/A | N/A | N/A | N/A | 2/12 (17%) vs 5/13 (38%) | N/A | N/A | Low, 3-1-1 |
| Park et al[26], 2014 | South Korea | Retrospective | 27 | FSGS undergoing KT | Age at KT: 39 ± 14 yr (n = 7, recurrence), 36 ± 11 yr (n = 20, no recurrence) | PP and IVGV infusion after each session of PP prior to transplantation, and RTX (375 mg/m2) was administeredwithin 1 wk prior to transplantation | Yes | Clinical confirmed by biopsy | 1/4 (25%) vs 5/18 (27%) | FSGS with recurrence had less graft survival than those without recurrence (P = 0.01) | N/A | High, 4-1-3 |
| Okumi et al[27], 2015 | Japan | Retrospective | 38 | FSGS undergoing KT | N/A | N/A | Yes | N/A | 5/23 (22%) vs 6/15 (40%) | 5/38 graft loss overall. Cr at yr 2 and 6 significantly lower in those who received both R + PP | N/A | Low, 3-1-1 |
| Futamura et al[28], 2016 | Japan | Retrospective | 28 | FSGS undergoing KT | N/A | N/A | Yes | N/A | 3/7 (43%) vs 5/21 (24%) | N/A | N/A | Low, 3-1-1 |
| Alasfar et al[29], 2018 | United States | Prospective | 64 | High-risk FSGS undergoing KT (2 of: white, age ≤ 30 at Dx, progression to ESKD ≤ 5 yr. Albumin < 3 g/dL during disease course, h/o failed KT due to recurrence) | Age at FSGS Dx: 29.9 ± 17.2. Age at KT: 38 ± 16.5 | Rituximab was given in 1 or 2 doses (375 mg/m2 per dose) | Yes; 3-10 sessions of PP day-7 to POD 2 | Clinical and biopsy | 23/37 (62%) vs 14/27 (51%) | Trend toward better renal allograft survival in nonrecurrent group comparedto the recurrent group (P = 0.0662) | 29.5 mo | High, 4-1-3 |
| Lu et al[30], 2018 | United States | Retrospective | 55 | High-risk FSGS undergoing KT considered (age ≤ 25 at Dx, proteinuria ≥ 5 g/d, progression to ESKD ≤ 5-7 yr) | Age at KT: 44 | One dose of rituximab (375 mg/m2, max 100 mg) | No | Proteinuria and biopsy | 4/7 (57%) vs 6/48 (13%) | Graft loss: 1/7 (14%) vs 8/48 (17%) | N/A | Fair, 3-2-2 |
| Auñón et al[31], 2021 | Spain | Retrospective, multicenter | 34 (93 total cohort) | High-risk FSGS undergoing KT considered (hypoalbuminemia and NS at baseline); genetic form excluded | Age at KT: 35.0 ± 15.2 (R group), 42.4 ± 12.2 (non-R group) | Rituximab, 1 g at induction and 1 g on day 14 after transplantation | No | Recurrence of proteinuria, confirmed by biopsy | 6/12 (50%) vs 9/22 (41%) | 53.5% with recurrence vs 88.5% in non-recurrence group | N/A | High, 4-1-3 |
| Mukku et al[39], 2021 | United States | Retrospective | 18 | FSGS undergoing KT | Age at KT: 35 yr | N/A | Yes | Recurrence of proteinuria | 0/8 vs 3/10 (30%) | 8/8 vs 9/10 | 30 (1-36) mo | Low, 3-1-1 |
N: Number; ESKD: End-stage kidney disease; FSGS: Focal segmental glomerulosclerosis; PP: Plasmapheresis; KT: Kidney transplantation; RTX: Rituximab; N/A: Not available.