Volume 85, Issue 2, Pages 425-430 (January 2014) Neither pre-transplant rituximab nor splenectomy affects de novo HLA antibody production after renal transplantation  Satoshi Ashimine, Yoshihiko Watarai, Takayuki Yamamoto, Takahisa Hiramitsu, Makoto Tsujita, Koji Nanmoku, Norihiko Goto, Asami Takeda, Akio Katayama, Kazuharu Uchida, Takaaki Kobayashi  Kidney International  Volume 85, Issue 2, Pages 425-430 (January 2014) DOI: 10.1038/ki.2013.291 Copyright © 2014 International Society of Nephrology Terms and Conditions

Figure 1 Graft survival. Graft survival: (a) death-uncensored and (b) death-censored. Graft survival in ABO-identical/compatible renal transplantation (ABO-Id/C, n=228) was compared with that in ABO-incompatible renal transplantation (ABO-I, n=92). ABO-I includes rituximab-treated (RIT, n=30), splenectomy-treated (SPX, n=51), and untreated renal transplantation (n=11) because of low anti-A/B antibody titer (≤8 × ). As rituximab pretreatment was started in 2008, graft survival in RIT was analyzed at 3 years. P<0.01: ABO-Id/C vs. ABO-I, ABO-Id/C vs. RIT P<0.001: ABO-Id/C vs. SPX. Kidney International 2014 85, 425-430DOI: (10.1038/ki.2013.291) Copyright © 2014 International Society of Nephrology Terms and Conditions

Figure 2 Frequency of de novo human leukocyte antigen (HLA) antibody production. Prevalence of de novo HLA antibody production was examined by immunosuppressive agents used in maintenance period. No significant difference was observed. ABO-I, ABO-incompatible renal transplantation; ABO-Id/C, ABO-identical/compatible renal transplantation; CSA, cyclosporine; EVR, everolimus; MMF, mycophenolate mofetil; MZR, mizoribine; RIT, rituximab; SPX, splenectomy; TAC, tacrolimus. Kidney International 2014 85, 425-430DOI: (10.1038/ki.2013.291) Copyright © 2014 International Society of Nephrology Terms and Conditions

Figure 3 Retrospective cohort study on 320 consecutive renal transplants without pretransplant donor-specific antibody (DSA). Among all living donor renal transplants (n=337) performed between 2005 and 2009, 320 without pretransplant DSA were enrolled for retrospective cohort study. Rituximab pretreatment was started in 2008, and neither rituximab or splenectomy pretreatment protocol was started in 2007. ABO-I, ABO-incompatible renal transplantation; ABO-identical/compatible renal transplantation; LD, living donor; No RIT/SPX, renal transplantation untreated with rituximab or splenectomy due to low anti-A/B antibody titer (≤8 × ); Pre-Tx, pretransplant; RIT, rituximab-treated renal transplantation; SPX; splenectomy-treated renal transplantation. Kidney International 2014 85, 425-430DOI: (10.1038/ki.2013.291) Copyright © 2014 International Society of Nephrology Terms and Conditions