Assessment of infectious complications in elderly kidney transplant recipients receiving induction with anti‐thymocyte globulin vs basiliximab

Pham, Christopher H; Kuten, Samantha A.; Knight, Richard J.; Nguyen, Duc T.; Graviss, Edward A.; Gaber, A. Osama

doi:10.1111/tid.13257

Cited by 18 publications

(15 citation statements)

References 20 publications

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“…However, a significantly higher proportion of ATG-induced patients were CMV-positive, which indicated that the patients induced by ATG were at higher risk of CMV infection. Our findings agreed with those reported previously in elderly kidney transplant patients [ 11 ]. On the contrary, some studies have reported no significant effect of induction therapies on CMV incidence in renal transplant patients [ 12 ].…”

Section: Discussionsupporting

confidence: 94%

Cytomegalovirus infection after renal transplantation

Atbee

Tuama

2022

JMedLife

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Renal transplant patients show a high prevalence of cytomegalovirus (CMV) infection after the procedure. This study was conducted to assess the prevalence and factors associated with the incidence of CMV infection among renal transplant patients. A total of 100 patients were recruited in this study. The CMV load in the blood of each patient was assessed using the technique of polymerase chain reaction (PCR). The serostatus of all recipients and donors was examined preoperatively and those of the recipients again postoperatively. The association of CMV load was assessed with the following factors: age, gender, alanine aminotransferase (ALT) and serum creatinine levels, types of immunosuppressive and induction regimens, preoperative diabetes status, and serological virologic response (SVR) at 12 weeks postoperatively. Our findings showed that CMV incidence was significantly higher in middle-aged patients (62 of 66 patients, 93.9%; p=0.0001). Furthermore, about 88.2% of patients induced by anti-thymocyte globulin (ATG) showed a high viral load, significantly higher than the proportion of CMV-positive patients induced by basiliximab (p=0.001). In addition, a higher proportion of CMV-negative recipients who received the graft from CMV-positive donors and vice-versa were CMV-positive postoperatively. Administration of Valcyte 450 showed 100% efficiency in decreasing the CMV load in the patients. Among all the assessed factors, only the age of the recipients, type of induction therapy used, and the preoperative serostatus of both donors and recipients were significantly associated with the postoperative CMV incidence among the patients.

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Section: Discussionsupporting

confidence: 94%

Cytomegalovirus infection after renal transplantation

Atbee

Tuama

2022

JMedLife

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“…Since the early spring of 2020, ATG use in kidney transplantation was significantly reduced, based mostly on previous reports about the increased risk of infectious complications, including death, in ATG-treated patients [ 20 – 22 ]. Importantly, a recent study confirmed that a higher ATG dosage in high-risk patients is associated with an increased risk of cytomegalovirus disease and death [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Safety of Antithymocyte Globulin Use in Kidney Graft Recipients During the COVID-19 Pandemic

Kolonko

Wiȩcek

2021

Ann Transplant

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Background There are many safety concerns regarding the use of antithymocyte globulin (ATG) in kidney transplant recipients (KTRs) during the ongoing COVID-19 pandemic. Hereby, we present our recent experience with ATG administration both as induction therapy and as an anti-rejection treatment. Material/Methods We retrospectively analyzed all patients transplanted during the first 12 months of the COVID-19 pandemic who were treated with thymoglobulin. The ATG dosing, lymphocyte number and percentage in blood smear, adverse effects (thrombocytopenia and infectious complications), and kidney graft function up to 12 months and patients’ outcomes were analyzed and compared to KTRs who received basiliximab induction. Results During pandemic, a total of 31 patients were treated with ATG and 59 received basiliximab. The median cumulative ATG doses were 275 (175–325) mg in the induction subgroup and 263 (200–275) mg in the anti-rejection treatment subgroup. Mild thrombocytopenia was noted in 7 (22.6%) and 13 (29.5%) patients, respectively. There were more infectious complications among patients treated with ATG as compared with the basiliximab subgroup (32.3 vs 10.2%, P <0.01), but there were similar incidence rates of thrombocytopenia. Kidney graft function up to 12 months after transplant was comparable (1.1 [1.0–1.9] vs 1.1 [1.0–1.4] mg/dl, respectively). Conclusions 1. ATG use in the induction protocol or as the anti-rejection treatment during the COVID-19 pandemic appears to be safe and the risk of adverse events is acceptable. 2. During the COVID-19 pandemic the necessary use of ATG should not be postponed, especially in KTRs with increased immunologic risk.

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“…In general, the tissues in elderly individuals are fragile and weak, and blood supply and tissue healing are known to worsen with age. Past reports have indicated older age as a risk factor for infectious complications in a variety of diseases [18][19][20]. Postoperative infectious complications lead to longer duration of hospitalization, higher medical costs, and, in the elderly, reduced activities of daily living [21].…”

Section: Discussionmentioning

confidence: 99%

Short-term outcomes after laparoscopic colorectal surgery in patients over 90 years old: a Japanese multicenter study

Yamashita

Tominaga

Nonaka

et al. 2023

Preprint

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Background The effect of laparoscopic surgery on short-term outcomes in colorectal cancer patients over 90 years old were still unknown. Methods We reviewed 87 colorectal cancer patients aged over 90 years who underwent surgery between 2016 and 2022. Patients were divided into an OP group (n = 22) that underwent open surgery and a LAP group (n = 65) that underwent laparoscopic surgery. Clinicopathological features were compared between groups. Results Seventy-eight patients (89.7%) had comorbidities. Frequency of advanced T stage was lower with laparoscopic surgery (p = 0.021). Operation time was longer (OP 146 min vs. LAP 203 min; p = 0.002) and blood loss was less (105 mL vs. 20 mL, p < 0.001) with laparoscopic surgery. Length of hospitalization was longer with open surgery (22 days vs. 18 days; p = 0.007). Frequency of infectious complications was lower with laparoscopic surgery (18.5%) than with open surgery (45.5%; p = 0.021). Multivariate analysis revealed open surgery (P = 0.026; odds ratio, 3.535; 95% confidence interval, 1.159–10.781) as an independent predictor of postoperative infectious complications. Conclusions Laparoscopic colorectal resection for patients over 90 years old is useful procedure that reduces postoperative infectious complications.

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Assessment of infectious complications in elderly kidney transplant recipients receiving induction with anti‐thymocyte globulin vs basiliximab

Cited by 18 publications

References 20 publications

Cytomegalovirus infection after renal transplantation

Cytomegalovirus infection after renal transplantation

Safety of Antithymocyte Globulin Use in Kidney Graft Recipients During the COVID-19 Pandemic

Short-term outcomes after laparoscopic colorectal surgery in patients over 90 years old: a Japanese multicenter study

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