Reduced dose rabbit anti-thymocyte globulin induction for prevention of acute rejection in high-risk kidney transplant recipients

Transplantation
Patrick KlemAlexander C Wiseman

Abstract

Despite the prevalent use of rabbit antithymocyte globulin (rATG) as an induction agent in kidney transplantation, the appropriate dose for preventing acute rejection in high-risk patients is not known. Few studies have examined total exposure of rATG less than 6 mg/kg, with fewer studies examining lower dose rATG in patients with increased risk factors for acute rejection. We retrospectively analyzed outcomes of 83 kidney transplant recipients at increased risk for acute rejection (repeat transplant, African American race, and panel reactive antibody > or =20%) from July 2004 to July 2007 who were treated with rATG 1.5 mg/kg per day for 3 (n=39) or 4 (n=44) doses for induction to determine the impact of reduced-exposure rATG in the prevention of acute rejection. rATG was initiated intraoperatively and continued on consecutive days. All patients received triple maintenance immunosuppression including prednisone and calcineurin inhibitor. Patients requiring dialysis within 48 hr after transplant were excluded from analysis. One-year acute rejection rates were 10% and 11% in the 3- and 4-dose cohorts, respectively, with 100% patient and graft survival at 1 year in both groups. Patients in the 3-dose cohort were discharged from th...Continue Reading

References

Feb 6, 2004·Clinical Transplantation·Matthias BüchlerUNKNOWN French Thymoglobuline Pharmacovigilance Study Group
Mar 12, 2005·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Ron ShapiroAlan B Leichtman
Oct 11, 2005·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Nicolas PalletChristophe Legendre
Apr 15, 2006·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·H-U Meier-KriescheA B Leichtman
Jun 15, 2006·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·P Randhawa, D C Brennan
Jul 11, 2006·Transplant International : Official Journal of the European Society for Organ Transplantation·Waichi WongNina Tolkoff-Rubin
Nov 10, 2006·The New England Journal of Medicine·Daniel C BrennanUNKNOWN Thymoglobulin Induction Study Group
Dec 21, 2006·JAMA : the Journal of the American Medical Association·Claire M VajdicAndrew E Grulich
May 24, 2008·Transplantation·Cheryle Gurk-TurnerAbdolreza Haririan

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Citations

Oct 13, 2015·Transplantation·Arezu Z AliabadiAndreas O Zuckermann
Nov 17, 2015·Transplantation·Luciano Potena, Emanuele Cozzi
Jan 3, 2013·Transplant International : Official Journal of the European Society for Organ Transplantation·Karen L HardingerChristina L Klein
Jan 21, 2014·Pediatric Transplantation·Wenjun ShangBaoping Qiao
Mar 2, 2013·Progress in Transplantation : Official Publication, North American Transplant Coordinators Organization ... [et Al.]·John W McGillicuddyPrabhakar K Baliga
Apr 26, 2016·Transplantation Proceedings·G Martinez-MierD Avila Y Falfan
Feb 22, 2018·Transplantation Direct·Namita SinghJohn P Vella
May 17, 2015·Clinical Journal of the American Society of Nephrology : CJASN·Alexander C Wiseman
Jan 25, 2020·The Cochrane Database of Systematic Reviews·Lawrence Mj BestKurinchi Selvan Gurusamy

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