Background. Rituximab is becoming increasingly utilized in renal transplant recipients; however, its association with infections remains unclear. Methods. We reviewed the incidence of viral and fungal infections in kidney transplant recipients treated with ( ) or without ( ) rituximab (RTX) in addition to standard immunosuppression. Results. Infections occurred in 134 (30%) patients, with a greater proportion in RTX versus no RTX patients (47% versus 28%; ). Viral infections occurred in 44% and 27% of RTX and no RTX patients, respectively ( ). This was largely driven by the frequency of BK viremia and noncytomegalovirus/non-BK viruses in RTX patients (27% versus 13% ( ) and 15% versus 2% ( ), resp.). Fungal infections also occurred more often in RTX patients (11% versus 3 %; ). Multivariate analysis revealed deceased donor recipient (odds ratio = 2.5; ) and rituximab exposure (odds ratio = 2.2; ) as independent risk factors for infection. Older patients, deceased donor recipients, those on dialysis longer, and those with delayed graft function tended to be at a greater risk for infections following rituximab. Conclusions. Rituximab is associated with an increased incidence of viral and fungal infections in kidney transplantation. Additional preventative measures and/or monitoring infectious complications may be warranted in those receiving rituximab. 1. Introduction The anti-CD20 monoclonal antibody rituximab (RTX) has become a more widely utilized therapy in the renal transplant population. RTX use has expanded from treatment of posttransplant lymphoproliferative disease to facilitation of ABO-incompatible transplantation, reduction of human leukocyte antigen (HLA) antibodies in highly sensitized patients, treatment of antibody mediated rejection (AMR), and treatment of recurrent and de novo renal diseases [1–4]. Each of these conditions represents a significant challenge in renal transplantation by which B-cell depletion with RTX may represent a promising intervention. It is well known that, with more potent immune suppression, the risk of infectious complications after transplant increases. T-lymphocyte depleting preparations in particular have been associated with an increased risk, as opposed to nonlymphocyte depleting agents which demonstrated similar infectious risks when compared to placebo [5, 6]. RTX has generally been considered to have an acceptable safety profile in hematological and autoimmune disorders; however, whether it can be used without an increased risk of infectious complications remains controversial in the immunosuppressed
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