"High-Risk Kidney Transplant Preconditioning Drugs, Low-Dose Adjustment Shows No Correlation with Cancer Side Effects"

Professor Kwon Hyun-wook's Research Team at Seoul Asan Hospital

Professor Kwon Hyun-wook of the Department of Kidney and Pancreas Transplantation Surgery at Seoul Asan Medical Center is examining a patient scheduled for a high-risk kidney transplant surgery.

[Asia Economy Reporter Lee Gwan-ju] A study has found that low-dose rituximab, used to reduce transplant rejection before high-risk kidney transplant surgery, is not associated with cancer occurrence.

Professor Kwon Hyun-wook's team from the Department of Kidney and Pancreas Transplant Surgery at Seoul Asan Medical Center compared cancer incidence rates among approximately 2,895 kidney transplant patients based on whether they received low-dose rituximab treatment before surgery, and announced on the 14th that there was no statistically significant difference.

In high-risk kidney transplant surgeries where the donor kidney has a different blood type or tissue incompatibility, a 'preoperative conditioning' process is performed to prevent the patient's immune system from attacking the newly transplanted kidney. During this process, a drug called rituximab is used.

Rituximab is an immunosuppressant that destroys B cells (immune cells) that produce antibodies causing rejection after kidney transplantation. It is a drug used in high doses for cancer treatments such as lymphoma and leukemia, but in patients undergoing blood type incompatible or tissue incompatible kidney transplants, it is used in low doses to reduce rejection after surgery.

However, recently, some in the academic community have suggested that even low-dose rituximab might increase the risk of cancer as a side effect. While previous studies showed that high-dose use lowers patients' immune function and increases cancer risk, there has been little research on low-dose use.

Accordingly, the research team followed 2,895 kidney transplant patients from January 2008 to January 2018, tracking 2,273 patients who did not receive preoperative rituximab injections and 622 patients who did, for an average of about 83 months and 72 months, respectively.

As a result, about 2.9% (65 patients) of those who did not receive rituximab developed cancer during the follow-up period, while about 1.9% (12 patients) of those who received rituximab developed cancer, showing no significant difference between the two groups.

In both groups, cancers occurred in the order of urinary tract, thyroid, blood, colon, breast, and stomach. Patient age and body mass index (BMI) were analyzed as the factors most closely related to cancer occurrence after kidney transplantation.

This study is meaningful in confirming that carefully controlled low-dose rituximab can be used in high-risk kidney transplant patients without side effects, allowing the new kidney to settle well.

Professor Kwon Hyun-wook explained, “Since patients scheduled for immunologically high-risk kidney transplants mainly visit Seoul Asan Medical Center, we have accumulated extensive experience in immune therapy. Based on this experience, the kidney transplant team at Seoul Asan Medical Center has applied the optimal rituximab dose that maximizes preoperative conditioning effects while minimizing side effects.”

The study results were recently published in the Journal of the Korean Surgical Society (Annals of Surgical Treatment and Research, IF=1.859).

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