Efficacy of anti-T-lymphocyte globulin-Fresenius as an induction agent in deceased-donor renal transplantation: A cohort study

Abstract

Anti-T-lymphocyte globulin (ATG) is frequently used in the induction regimen of renal transplantation, but its dose has not been standardized. In the present study, the efficacy of different ATG-Fresenius (ATG-F) doses was assessed in recipients of renal transplantation. A total of 131 adult recipients of renal transplantation who received ATG-F induction between August 2015 and July 2018 were included. The incidence of biopsy-confirmed acute rejection, graft function, as well as graft and patient survival within 12 months post-transplant, was assessed, and adverse events, including hematologic and infection-associated side effects, were compared between patients receiving a cumulative ATG-F dose of <7 or ≥7 mg/kg. The incidence of biopsyconfirmed acute rejection was similar between patients receiving cumulative doses of <7 and ≥7 mg/kg (7.5 vs. 4.7%, P=0.766). The incidence of infection within 12 months was lower in the ATG-F <7 mg/kg group compared with that in the ≥7 mg/kg group (26.9 vs. 50.0%, P= 0.006), but the incidence of pneumonia did not differ between the ATG-F <7 and ≥7 mg/kg groups (10.4 vs. 20.3%, P= 0.117). The incidence of urinary infection was higher in the ≥7 mg/kg group than in the <7 mg/kg group (20.4 vs. 7.46%, P= 0.033), while the extent and duration of anemia and lymphopenia was similar between groups. There was no difference in graft function, delayed graft function, as well as overall and graft survival between the groups. In conclusion, a moderate reduction in the cumulative ATG-F dose was not associated with an increased risk of acute rejection, while the risk of infection was reduced. Optimization of the ATG-F dose for induction may facilitate the reduction of the risk of infection without compromising the induction efficacy in renal transplant recipients.

Endoplasmic reticulum stress in the adipose tissue and monocyte chemoattractant protein‐1 are involved in tacrolimus‐induced diabetes mellitus

“…High tacrolimus trough levels have been associated with a high incidence of new‐onset diabetes in the first year after transplantation, 20 while reduced tacrolimus trough levels in the first 3 months after transplantation were found to lower the prevalence of NODAT 21 . In the present study, the incidence of NODAT during the first year (12.7%) was lower than the incidence rates reported in most international studies, 22 possibly because our center aims to maintain optimal tacrolimus cutoff levels during the early post‐transplantation period depending on the level of immunological risk 23 . However, the precise cutoff value of tacrolimus trough levels that is associated with the risk of NODAT is yet to be determined.…”

“… 21 In the present study, the incidence of NODAT during the first year (12.7%) was lower than the incidence rates reported in most international studies, 22 possibly because our center aims to maintain optimal tacrolimus cutoff levels during the early post‐transplantation period depending on the level of immunological risk. 23 However, the precise cutoff value of tacrolimus trough levels that is associated with the risk of NODAT is yet to be determined. Maes et al 24 found that patients with high tacrolimus trough levels (>15 ng/mL) during the first month after transplantation were at risk for the development of NODAT, while Rodrigo et al 19 considered that NODAT was prone to develop during the first year after transplantation when the tacrolimus trough level exceeded 20 ng/mL in the early post‐transplantation period.…”

A-45-Year-Old Female, ABO Matched Living Related Kidney Transplant Recipient, Treatment Completed Hepatitis C Infection, Who Received Anti-Thymocyte Globulin as Induction Therapy Developed Pancytopenia and Acute Antibody Mediated Rejection Recovered with Plasmapheresis, Intravenous Immunoglobulin and Rituximab: Balancing Efficacy, Safety, and Cost!

“…Her platelet count was low till 'Day 30'. Anaemia, leukopenia and thrombocytopenia were commonly observed adverse reactions to administration of rATG, found in other studies [18]. The hematological side effects may be aggravated by mycophenolate mofetil and Having thrombocytopenia in this patient delayed the timing of graft biopsy; it can be done only on 'Day 7' after correction with platelet transfusion.…”

Efficacy of Low-Dose Trimethoprim/Sulfamethoxazole for the Treatment of Pneumocystis jirovecii Pneumonia in Deceased Donor Kidney Recipients

“…ATG-F was administered as described previously. 11 Maintenance therapy with oral tacrolimus, MPA, corticosteroids, and prophylaxis for P. jiroveci and cytomegalovirus (CMV) also was administered as described previously. 11 …”