{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:26:09Z","timestamp":1787725569053,"version":"build-2784847793"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100012330","name":"Okayama University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100012330","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Exp Nephrol"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      ABO-mismatched kidney transplantation (KTx) expands donor availability but increases risks of antibody-mediated rejection and passenger lymphocyte syndrome (PLS). While rituximab (Rit) potentially mitigates these complications, conventional high-dose regimens (375\u00a0mg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) elevate infectious and hematologic toxicity. We implemented low-dose Rit induction (200\u00a0mg\/body) for desensitization in minor\/major ABO-mismatched and DSA-positive KTx, evaluating its efficacy and safety over 15-years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective cohort (May 2009\u2013April 2024) analyzed 161 adult KTx recipients: Rit (n\u2009=\u2009107) and Non-Rit (n\u2009=\u200954) groups. All received tacrolimus, mycophenolate mofetil, prednisolone, and basiliximab; high-risk patients also underwent plasmapheresis. Outcomes included graft survival, biopsy-proven acute rejection, de novo donor-specific antibody (DSA) formation, infection, severe neutropenia, and PLS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      1-year graft survival was 100% in both groups. 5-year death-censored graft survival was 95.8% (Rit) vs 95.9% (Non-Rit), respectively (log-rank\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.43). Biopsy-proven acute rejection (7.5% vs 3.7%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.50) and de novo DSA production were equivalent (Class I: 5.5% vs 2.2%; Class II: 6.6% vs 8.7%; both\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20091.00), with lower mean fluorescent intensity (MFI) in the Rit group. Cytomegalovirus disease, urinary tract infection and fungal infection rates were comparable between both groups. Grade 4 neutropenia was not associated with Rit (OR 2.65; 95% CI 0.63\u201311.0;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.18). Blood transfusion for hemoglobin declines occurred in 5.6% vs 7.4%, with preserved haptoglobin in all cases, indicating no PLS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Low-dose Rit induction achieves excellent graft survival and effective PLS prevention, without increasing toxicity, supporting its adoption as an optimal desensitization strategy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10157-026-02882-1","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T03:05:15Z","timestamp":1779764715000},"page":"1359-1367","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing low-dose rituximab protocol for ABO-mismatched kidney transplantation: long-term outcomes in a single-center retrospective cohort study"],"prefix":"10.1007","volume":"30","author":[{"given":"Tomoaki","family":"Yamanoi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takanori","family":"Sekito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moto","family":"Tokunaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ichiro","family":"Tsuboi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kasumi","family":"Yoshinaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Maruyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsushi","family":"Kawada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Risa","family":"Kubota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Tominaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Sadahira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Katayama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takehiro","family":"Iwata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shingo","family":"Nishimura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kensuke","family":"Bekku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiro","family":"Onishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidemi","family":"Takeuchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsuyuki","family":"Tanabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Morinaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichiro","family":"Wada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3172-2482","authenticated-orcid":false,"given":"Motoo","family":"Araki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"issue":"2","key":"2882_CR1","doi-asserted-by":"publisher","first-page":"471","DOI":"10.2215\/CJN.05021107","volume":"3","author":"M Abecassis","year":"2008","unstructured":"Abecassis M, Bartlett ST, Collins AJ, et al. Kidney transplantation as primary therapy for end-stage renal disease: a National Kidney Foundation\/Kidney Disease Outcomes Quality Initiative (NKF\/KDOQI\u2122) conference. Clin J Am Soc Nephrol. 2008;3(2):471\u201380.","journal-title":"Clin J Am Soc Nephrol"},{"issue":"6","key":"2882_CR2","doi-asserted-by":"publisher","first-page":"1485","DOI":"10.1007\/s11136-019-02113-z","volume":"28","author":"DCS de Brito","year":"2019","unstructured":"de Brito DCS, Machado EL, Reis IA, et al. Modality transition on renal replacement therapy and quality of life of patients: a 10-year follow-up cohort study. Qual Life Res. 2019;28(6):1485\u201395.","journal-title":"Qual Life Res"},{"key":"2882_CR3","unstructured":"Inui M, Ishida H, Omoto K, et al. Kidney transplantation at Tokyo Women\u2019s Medical University. Clin Transpl. 2011:127\u201343."},{"key":"2882_CR4","doi-asserted-by":"publisher","DOI":"10.12659\/AOT.927420","volume":"25","author":"Y Ko","year":"2020","unstructured":"Ko Y, Kim JY, Kim SH, et al. Acute rejection and infectious complications in ABO- and HLA-incompatible kidney transplantations. Ann Transplant. 2020;25:e927420.","journal-title":"Ann Transplant"},{"issue":"4","key":"2882_CR5","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1056\/NEJMoa1012376","volume":"365","author":"RA Montgomery","year":"2011","unstructured":"Montgomery RA, Lonze BE, King KE, et al. Desensitization in HLA-incompatible kidney recipients and survival. N Engl J Med. 2011;365(4):318\u201326.","journal-title":"N Engl J Med"},{"issue":"6","key":"2882_CR6","doi-asserted-by":"publisher","first-page":"878","DOI":"10.1111\/j.1399-0012.2010.01384.x","volume":"25","author":"H Shirakawa","year":"2011","unstructured":"Shirakawa H, Ishida H, Shimizu T, et al. The low dose of rituximab in ABO-incompatible kidney transplantation without a splenectomy: a single-center experience. Clin Transplant. 2011;25(6):878\u201384.","journal-title":"Clin Transplant"},{"issue":"10","key":"2882_CR7","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1111\/j.1432-2277.2009.00903.x","volume":"22","author":"H Nishida","year":"2009","unstructured":"Nishida H, Ishida H, Tanaka T, et al. Cytomegalovirus infection following renal transplantation in patients administered low-dose rituximab induction therapy. Transpl Int. 2009;22(10):961\u20139.","journal-title":"Transpl Int"},{"issue":"1","key":"2882_CR8","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1111\/j.1744-9987.2010.00856.x","volume":"15","author":"T Hirai","year":"2011","unstructured":"Hirai T, Ishida H, Toki D, et al. Comparison of the acute rejection incidence rate in spousal donor transplantation before and after anti-CD20 antibody (Rituximab) protocol as desensitization therapy. Ther Apher Dial. 2011;15(1):89\u201397.","journal-title":"Ther Apher Dial"},{"issue":"4","key":"2882_CR9","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1007\/s10157-016-1321-5","volume":"21","author":"K Takahashi","year":"2017","unstructured":"Takahashi K, Saito K, Takahara S, et al. Results of a multicenter prospective clinical study in Japan for evaluating efficacy and safety of desensitization protocol based on rituximab in ABO-incompatible kidney transplantation. Clin Exp Nephrol. 2017;21(4):705\u201313.","journal-title":"Clin Exp Nephrol"},{"issue":"8","key":"2882_CR10","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1097\/TP.0000000000000362","volume":"98","author":"PS Macklin","year":"2014","unstructured":"Macklin PS, Morris PJ, Knight SR. A systematic review of the use of Rituximab for desensitization in renal transplantation. Transplant. 2014;98(8):794\u2013805.","journal-title":"Transplant"},{"issue":"6","key":"2882_CR11","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1111\/tri.12072","volume":"26","author":"ANR Barnett","year":"2013","unstructured":"Barnett ANR, Hadjianastassiou VG, Mamode N. Rituximab in renal transplantation. Transpl Int. 2013;26(6):563\u201375.","journal-title":"Transpl Int"},{"issue":"12","key":"2882_CR12","doi-asserted-by":"publisher","first-page":"1136","DOI":"10.1111\/iju.14382","volume":"27","author":"K Yoshinaga","year":"2020","unstructured":"Yoshinaga K, Araki M, Wada K, et al. Low-dose rituximab induction therapy is effective in immunological high-risk renal transplantation without increasing cytomegalovirus infection. Int J Urol. 2020;27(12):1136\u201342.","journal-title":"Int J Urol"},{"issue":"3","key":"2882_CR13","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1016\/j.transproceed.2024.01.026","volume":"56","author":"JH Lee","year":"2024","unstructured":"Lee JH, Lee HR, Lee SW, et al. Effect of induction therapy dose on survival in ABO-incompatible kidney transplantation: A network meta-analysis using recent data. Transplant Proc. 2024;56(3):511\u20134.","journal-title":"Transplant Proc"},{"issue":"10","key":"2882_CR14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0224203","volume":"14","author":"Y Tomita","year":"2019","unstructured":"Tomita Y, Iwadoh K, Ogawa Y, et al. Single fixed low-dose rituximab as induction therapy suppresses de novo donor-specific anti-HLA antibody production in ABO compatible living kidney transplant recipients. PLoS ONE. 2019;14(10):e0224203.","journal-title":"PLoS ONE"},{"key":"2882_CR15","first-page":"295","volume":"70","author":"M Araki","year":"2016","unstructured":"Araki M, Wada K, Mitsui Y, et al. The efficacy of rituximab in high-risk renal transplant recipients. Acta Med Okayama. 2016;70:295\u20137.","journal-title":"Acta Med Okayama"},{"issue":"3","key":"2882_CR16","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1016\/j.tmrv.2020.06.004","volume":"34","author":"MM Moosavi","year":"2020","unstructured":"Moosavi MM, Duncan A, Stowell SR, et al. Passenger lymphocyte syndrome; a review of the diagnosis, treatment, and proposed detection protocol. Transfus Med Rev. 2020;34(3):178\u201387.","journal-title":"Transfus Med Rev"},{"key":"2882_CR17","doi-asserted-by":"publisher","DOI":"10.1016\/j.trim.2022.101605","volume":"73","author":"H Zhao","year":"2022","unstructured":"Zhao H, Ding Z, Luo Z, et al. Passenger lymphocyte syndrome in renal transplantation: a systematic review of published case reports. Transpl Immunol. 2022;73:101605.","journal-title":"Transpl Immunol"},{"issue":"3","key":"2882_CR18","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2023-259259","volume":"17","author":"A Mathavan","year":"2024","unstructured":"Mathavan A, Krekora U, Kleehammer AC, et al. Passenger lymphocyte syndrome following minor ABO-mismatched liver transplantation. BMJ Case Rep. 2024;17(3):e259259.","journal-title":"BMJ Case Rep"},{"issue":"6","key":"2882_CR19","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14556","volume":"27","author":"GE Yeom","year":"2023","unstructured":"Yeom GE, Lim SH, Kim JH, et al. Gastrointestinal involvement of passenger lymphocyte syndrome followed by minor ABO-incompatible renal transplantation: A case report. Pediatr Transplant. 2023;27(6):e14556.","journal-title":"Pediatr Transplant"},{"issue":"2","key":"2882_CR20","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1046\/j.1537-2995.2002.00026.x","volume":"42","author":"RJ Sokol","year":"2002","unstructured":"Sokol RJ, Stamps R, Booker DJ, et al. Posttransplant immune-mediated hemolysis. Transfusion. 2002;42(2):198\u2013204.","journal-title":"Transfusion"},{"issue":"8","key":"2882_CR21","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1007\/s00147-002-0442-9","volume":"15","author":"H Ishida","year":"2002","unstructured":"Ishida H, Tanabe K, Tokumoto T, et al. The evaluation of graft irradiation as a method of preventing hemolysis after ABO-mismatched renal transplantation. Transpl Int. 2002;15(8):421\u20134.","journal-title":"Transpl Int"},{"issue":"2-3","key":"2882_CR22","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.trim.2013.01.003","volume":"28","author":"H Ishida","year":"2013","unstructured":"Ishida H, Inui M, Furusawa M, et al. Late-onset neutropenia (LON) after low-dose Rituximab treatment in living related kidney transplantation--single-center study. Transpl Immunol. 2013;28(2\u20133):93\u20139.","journal-title":"Transpl Immunol"},{"issue":"4","key":"2882_CR23","doi-asserted-by":"publisher","first-page":"456","DOI":"10.6002\/ect.2016.0261","volume":"17","author":"S Nishide","year":"2019","unstructured":"Nishide S, Uchida J, Kaei K, et al. Passenger lymphocyte syndrome in the ABO-incompatible kidney transplant recipient receiving Rituximab. Exp Clin Transplant. 2019;17(4):456\u20139.","journal-title":"Exp Clin Transplant"},{"issue":"1","key":"2882_CR24","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1111\/1744-9987.12483","volume":"21","author":"K Tsujimura","year":"2017","unstructured":"Tsujimura K, Ishida H, Tanabe K. Is efficacy of the anti-CD20 antibody Rituximab preventing hemolysis due to passenger lymphocyte syndrome? Ther Apher Dial. 2017;21(1):22\u20135.","journal-title":"Ther Apher Dial"},{"issue":"3","key":"2882_CR25","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1038\/bmt.2012.244","volume":"48","author":"Y Kanda","year":"2013","unstructured":"Kanda Y. Investigation of the freely available easy-to-use software \u201cEZR\u201d for medical statistics. Bone Marrow Transplant. 2013;48(3):452\u20138.","journal-title":"Bone Marrow Transplant"},{"issue":"1","key":"2882_CR26","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1111\/nyas.13562","volume":"1413","author":"M Marino","year":"2018","unstructured":"Marino M, Bartoccioni E, Alboini PE, et al. Rituximab in myasthenia gravis: a \u201cto be or not to be\u201d inhibitor of T cell function. Ann N Y Acad Sci. 2018;1413(1):41\u20138.","journal-title":"Ann N Y Acad Sci"},{"issue":"1","key":"2882_CR27","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1007\/s12016-008-8074-1","volume":"34","author":"A Kessel","year":"2008","unstructured":"Kessel A, Rosner I, Toubi E. Rituximab: beyond simple B cell depletion. Clin Rev Allergy Immunol. 2008;34(1):74\u20139.","journal-title":"Clin Rev Allergy Immunol"},{"issue":"2","key":"2882_CR28","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1111\/j.1600-6143.2011.03833.x","volume":"12","author":"EG Kamburova","year":"2012","unstructured":"Kamburova EG, Koenen HJPM, Boon L, et al. In vitro effects of rituximab on the proliferation, activation and differentiation of human B cells. Am J Transplant. 2012;12(2):341\u201350.","journal-title":"Am J Transplant"},{"issue":"2","key":"2882_CR29","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1111\/j.1600-6143.2006.01632.x","volume":"7","author":"EJ Ramos","year":"2007","unstructured":"Ramos EJ, Pollinger HS, Stegall MD, et al. The effect of desensitization protocols on human splenic B-cell populations in vivo. Am J Transplant. 2007;7(2):402\u20137.","journal-title":"Am J Transplant"},{"issue":"8","key":"2882_CR30","doi-asserted-by":"publisher","first-page":"1357","DOI":"10.1111\/j.1600-6143.2004.00502.x","volume":"4","author":"A Agarwal","year":"2004","unstructured":"Agarwal A, Vieira CA, Book BK, et al. Rituximab, anti-CD20, induces in vivo cytokine release but does not impair ex vivo T-cell responses. Am J Transplant. 2004;4(8):1357\u201360.","journal-title":"Am J Transplant"}],"container-title":["Clinical and Experimental Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10157-026-02882-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10157-026-02882-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10157-026-02882-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T05:46:36Z","timestamp":1787723196000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10157-026-02882-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":30,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["2882"],"URL":"https:\/\/doi.org\/10.1007\/s10157-026-02882-1","relation":{},"ISSN":["1342-1751","1437-7799"],"issn-type":[{"value":"1342-1751","type":"print"},{"value":"1437-7799","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,26]]},"assertion":[{"value":"15 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"None of the authors have any conflicts of interest associated with this study.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Okayama University Institutional Review Board (registration number: 1911\u2014030) and complied with the Declaration of Helsinki and current ethical guidelines. Written consent was waived because of the study\u2019s retrospective nature, and patients provided consent via an opt-out approach.","order":2,"name":"Ethics","label":"Ethical approval and informed consent","group":{"name":"EthicsHeading","label":"Declarations"}}]}}