Rituximab for Pediatric Renal Transplant Rejection

Inclusion Criteria:Patients must meet the following inclusion criteria to be eligible for
study entry:

   - Pediatric renal allograft recipients aged 2-21 years with biopsy proven acute
   rejection episodes.

   - Able and willing to give written informed consent and comply with the requirements of
   the study protocol (patients >18 years of age or parents)

   - Greater than 30% decline in baseline renal function as indicated by a rise in the
   serum creatinine.

   - Adequate liver function, as indicated by AST or ALT <2x upper limit of normal unless
   related to primary disease.

   - Negative serum pregnancy test (for women of child bearing age)

   - Men and women of reproductive potential must agree to use an acceptable method of
   birth control during treatment and for twelve months (1 year) after completion of
   treatment.

Exclusion Criteria:Patients will be excluded from the study based on the following
criteria:

   - Treatment with any investigational agent within 4 weeks of screening or 5 half-lives
   of the investigational drug (whichever is longer)

   - Receipt of a live vaccine within 4 weeks prior to randomization

   - Previous Treatment with Rituximab (MabThera® / Rituxan®)

   - History of severe allergic or anaphylactic reactions to humanized or murine monoclonal
   antibodies

   - History of HIV (positive HIV, HIV conducted during screening if applicable)

   - History of Hepatitis B and/or Hepatitis C (Hep B/C at screening)

   - History of recurrent significant infection or history of recurrent bacterial
   infections

   - Known active bacterial, viral, fungal, mycobacterial, or other infection (including
   tuberculosis or atypical mycobacterial disease, but excluding fungal infections of
   nail beds) or any major episode of infection requiring hospitalization or treatment
   with IV antibiotics within 4 weeks of screening or oral antibiotics within 2 weeks
   prior to screening

   - Ongoing use of high dose steroids (>10mg/day) or unstable steroid dose in the past 4
   weeks.

   - Lack of peripheral venous access

   - History of drug, alcohol, or chemical abuse within 6 months prior to screening

   - Pregnancy (a negative serum pregnancy test should be performed for all women of
   childbearing potential within 7 days of treatment) or lactation

   - Concomitant malignancies or previous malignancies within the last five years, with the
   exception of adequately treated basal or squamous cell carcinoma of the skin or
   carcinoma in situ of the cervix.

   - History of psychiatric disorder

   - Significant cardiac or pulmonary disease (including obstructive pulmonary disease)

   - Any other disease, metabolic dysfunction, physical examination finding, or clinical
   laboratory finding giving reasonable suspicion of a disease or condition that
   contraindicates the use of an investigational drug or that may affect the
   interpretation of the results or render the patient at high risk from treatment
   complications

   - Inability to comply with study and follow-up procedures