ATG induction in renal transplant recipients: Long-term hazard of severe infection is associated with long-term functional T cell impairment but not the ATG-induced CD4 cell decline

Weimer, Rolf; Ettrich, Maryam; Renner, Fritz; Dietrich, Hartmut; Süsal, Caner; Deisz, Sabine; Padberg, Winfried; Opelz, Gerhard

doi:10.1016/j.humimm.2014.02.015

Cited by 11 publications

(12 citation statements)

References 48 publications

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“…For example, in a cohort of kidney transplant recipients, the use of ATG was associated with the development of severe infections late after transplantation only in patients with impaired T-cell proliferation, but this was independent on the absolute numbers of CD4+ cells. Also, CD4+ cell counts were not associated with Il-2 expression or CD4 helper activity, supporting our data of an appropriate multifunctional specific T-cell response to influenza vaccine in patients with low CD4+ cell counts [7,39].…”

Section: Discussionsupporting

confidence: 83%

Humoral, T-cell and B-cell immune responses to seasonal influenza vaccine in solid organ transplant recipients receiving anti-T cell therapies

Héquet

Pascual

Lartey

et al. 2016

Vaccine

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Section: Discussionsupporting

confidence: 83%

Humoral, T-cell and B-cell immune responses to seasonal influenza vaccine in solid organ transplant recipients receiving anti-T cell therapies

Héquet

Pascual

Lartey

et al. 2016

Vaccine

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“…A recent study showed that ATG induction was associated with long-term impairment of T cell function and related infections, even after the patients had normalized CD4 counts [24]. This finding is also a reminder that the CD4 counts incompletely assesses the recovery of an immunocompetent CD4 T cell pool.…”

Section: Discussionmentioning

confidence: 99%

Kidney transplant outcomes in HIV-positive patients: a systematic review and meta-analysis

et al. 2019

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BackgroundKidney transplantation is now a viable alternative to dialysis in HIV-positive patients who achieve good immunovirological control with the currently available antiretroviral therapy regimens. This systematic review and meta-analysis investigate the published evidence of outcome and risk of kidney transplantation in HIV-positive patients following the PRISMA guidelines.MethodsSearches of PubMed, the Cochrane Library and EMBASE identified 27 cohort studies and 1670 case series evaluating the survival of HIV-positive kidney transplant patients published between July 2003 and May 2018. The regimens for induction, maintenance therapy and highly active antiretroviral therapy, acute rejection, patient and graft survival, CD4 count and infectious complications were recorded. We evaluated the patient survival and graft survival at 1 and 3 years respectively, acute rejection rate and also other infectious complications by using a random-effects analysis.ResultsAt 1 year, patient survival was 0.97 (95% CI 0.95; 0.98), graft survival was 0.91 (95% CI 0.88; 0.94), acute rejection was 0.33 (95% CI 0.28; 0.38), and infectious complications was 0.41 (95% CI 0.34; 0.50), and at 3 years, patient survival was 0.94 (95% CI 0.90; 0.97) and graft survival was 0.81 (95% CI 0.74; 0.87).ConclusionsWith careful selection and evaluation, kidney transplantation can be performed with good outcomes in HIV-positive patients.

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“…T cell-depleting agents have persistent immunologic effects lasting 1-2 years such that live vaccinations are recommended to be deferred until the stated time period has elapsed-1 year after receipt of ATG and 2 years after receipt of alemtuzumab. [43][44][45][46] Novel biologic agents, for example, obinutuzumab, are increasingly being used for various indications in pediatric transplantation, and until long-term data regarding immune reconstitution after use of such agents are available, we recommend deferring live vaccination in these recipients. 47 Group 2: Proceed with vaccine: Patients for whom live vaccination is likely to be safe.…”

Section: Supporting Information or Evidencementioning

confidence: 99%

“…CMV infection that requires antivirals can be a sign of underlying T‐cell dysfunction, and as such, live vaccine should be held until episode resolved. T cell–depleting agents have persistent immunologic effects lasting 1‐2 years such that live vaccinations are recommended to be deferred until the stated time period has elapsed—1 year after receipt of ATG and 2 years after receipt of alemtuzumab . Novel biologic agents, for example, obinutuzumab, are increasingly being used for various indications in pediatric transplantation, and until long‐term data regarding immune reconstitution after use of such agents are available, we recommend deferring live vaccination in these recipients …”

Section: Outcomementioning

confidence: 99%

“…ATG is a polyclonal antibody that depletes T cells in peripheral blood and to some extent lymphoid tissue. Long‐term immunologic studies of patients who receive ATG indicate immune abnormalities persist up to 1‐2 years after administration specifically with regard to T‐cell function (proliferative capacity and cytokine production) . Thus, if ATG has been given in the past 24 months, further immunologic investigation is warranted prior to live vaccination, and live vaccination should be deferred if given less than 12 months ago.…”

Section: Outcomementioning

confidence: 99%

See 1 more Smart Citation

Live vaccines after pediatric solid organ transplant: Proceedings of a consensus meeting, 2018

Suresh

Upton

Green

et al. 2019

Pediatric Transplantation

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Growing evidence suggests receipt of live‐attenuated viral vaccines after solid organ transplant (SOT) has occurred and is safe and needed due to lapses in herd immunity. A 2‐day consortium of experts in infectious diseases, transplantation, vaccinology, and immunology was held with the objective to review evidence and create expert recommendations for clinicians when considering live viral vaccines post‐SOT. For consideration of VV and MMR post‐transplant, evidence exists only for kidney and liver transplant recipients. For MMR vaccine post‐SOT, consider vaccination during outbreak or travel to endemic risk areas. Patients who have received antiproliferative agents (eg. mycophenolate mofetil), T cell–depleting agents, or rituximab; or have persistently elevated EBV viral loads, or are in a state of functional tolerance, should be vaccinated with caution and have a more in‐depth evaluation to define benefit of vaccination and net state of immune suppression prior to considering vaccination. MMR and/or VV (not combined MMRV) is considered to be safe in patients who are clinically well, are greater than 1 year after liver or kidney transplant and 2 months after acute rejection episode, can be closely monitored, and meet specific criteria of “low‐level” immune suppression as defined in the document.

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ATG induction in renal transplant recipients: Long-term hazard of severe infection is associated with long-term functional T cell impairment but not the ATG-induced CD4 cell decline

Cited by 11 publications

References 48 publications

Humoral, T-cell and B-cell immune responses to seasonal influenza vaccine in solid organ transplant recipients receiving anti-T cell therapies

Humoral, T-cell and B-cell immune responses to seasonal influenza vaccine in solid organ transplant recipients receiving anti-T cell therapies

Kidney transplant outcomes in HIV-positive patients: a systematic review and meta-analysis

Live vaccines after pediatric solid organ transplant: Proceedings of a consensus meeting, 2018

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