Induction versus noninduction therapy in kidney transplantation: considering different PRA levels and different induction therapies

Castro, Maria Cristina Ribeiro de; Araújo, Lucília; Nahas, William Carlos; Arap, Sami; David‐Neto, Elias; Ianhez, Luiz Estevam

doi:10.1016/j.transproceed.2004.03.084

Cited by 27 publications

(20 citation statements)

References 13 publications

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“…Table 4 summarizes the most relevant retrospective studies. One large analysis of 763 patients undergoing kidney transplantation during 1995 to 2001 found no cases of PTLD in any induction-treated patient, but only 213 individuals received induction and only 71 were given rATG [73]. Two other large retrospective analyses did not specifically consider rATG, but found no effect of ATG preparations in general [74,75] on the risk of PTLD.…”

Section: Retrospective Studiesmentioning

confidence: 99%

Rabbit antithymocyte globulin induction and risk of post-transplant lymphoproliferative disease in adult and pediatric solid organ transplantation: An update

Hertig

Zuckermann

2015

Transplant Immunology

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The most modifiable risk factor for post-transplant lymphoproliferative disease (PTLD) is the type and dose of induction and maintenance immunosuppressive therapy. It is challenging to identify the contribution of a single agent such as rabbit antithymocyte globulin (rATG) in the setting of multidrug therapy. Registry analyses can be helpful but are limited by methodological restrictions and inclusion of historical patient cohorts. These are typically from eras when rATG dosing was markedly higher than current dosing (e.g. total dose 14 mg/kg versus 6 mg/kg now), accompanied by higher exposure to maintenance therapies, and often an absence of antiviral prophylaxis. The largest registry analysis to assess rATG specifically found no risk of PTLD after kidney transplantation, but conflicting results have been reported, highlighting the difficulty of interpreting this type of analysis. The relative rarity of PTLD means that individually controlled trials are underpowered to assess its occurrence, but the available data do not suggest an effect of rATG. A pooled analysis of data from studies of rATG induction in kidney and heart transplantation found the incidence of PTLD to be comparable to published reports in the overall transplant population. Data on the effect of rATG dose are inconclusive, but in patients receiving antiviral prophylaxis it does not appear to be influential. Nevertheless, it would seem reasonable to employ the lowest dose of rATG compatible with effective induction, particularly in EBV-seronegative recipients and other high-risk groups such as heart-lung transplant recipients. Overall, the risk of PTLD following rATG induction therapy with modern dosing regimens and under current management conditions appears unlikely to make an important contribution to the risk:benefit balance.

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Section: Retrospective Studiesmentioning

confidence: 99%

Rabbit antithymocyte globulin induction and risk of post-transplant lymphoproliferative disease in adult and pediatric solid organ transplantation: An update

Hertig

Zuckermann

2015

Transplant Immunology

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“…Patients taking IL-2 receptor antagonists could expect their no-induction probability of acute rejection to be reduced by 28%, 26 and patients treated with muromonab CD3 and equine antithymocyte globulin could expect their no-induction probability to be reduced by 9%. [27][28][29] Calculated first-year, no-induction acute rejection probabilities for each regimen are presented in Table 2. The probability of acute rejection in year 2 after transplantation was assumed to be 2.86% 30 and was assumed to decline linearly to a probability of 0% over a 10-yr time horizon.…”

Section: Clinical Efficacymentioning

confidence: 99%

Lifetime Cost-Effectiveness of Calcineurin Inhibitor Withdrawal After De Novo Renal Transplantation

Earnshaw

Graham

Irish

et al. 2008

Journal of the American Society of Nephrology

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After renal transplantation, immunosuppressive regimens associated with high short-term survival rates are not necessarily associated with high long-term survival rates, suggesting that regimens may need to be optimized over time. Calcineurin inhibitor (CNI) withdrawal from a sirolimus-based immunosuppressive regimen may maximize the likelihood of long-term graft and patient survival by minimizing CNIassociated nephrotoxicity. In this study, a lifetime Markov model was created to compare the costeffectiveness of a sirolimus-based CNI withdrawl regimen (sirolimus plus steroids) with other common CNI-containing regimens in adult de novo renal transplantation patients. Long-term graft survival was estimated by renal function and data from published studies and the US transplant registry, including short-and long-term outcomes, utility weights, and health-state costs were incorporated. Drug costs were based on average daily consumption and wholesale acquisition costs. The model suggests that treatment with sirolimus plus steroids is more efficacious and less costly than regimens consisting of a CNI, mycophenolate mofetil, and steroids; therefore, CNI withdrawal not only shows potential for long-term clinical benefits but also is expected to be cost-saving over a patient's life compared with the most commonly prescribed CNI-containing regimens.

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“…Antibody induction agents in renal transplantation are highly effective in reducing acute rejection (1) and ultimately in preserving allograft function (2). Use of induction agents has increased over recent years and by 2005, nearly 75% of renal transplants in the United States were performed with induction therapy compared with 39% utilization in 1998 (3).…”

Section: Introductionmentioning

confidence: 99%

Early Outcomes of Thymoglobulin and Basiliximab Induction in Kidney Transplantation: Application of Statistical Approaches to Reduce Bias in Observational Comparisons

et al. 2009

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Induction versus noninduction therapy in kidney transplantation: considering different PRA levels and different induction therapies

Cited by 27 publications

References 13 publications

Rabbit antithymocyte globulin induction and risk of post-transplant lymphoproliferative disease in adult and pediatric solid organ transplantation: An update

Rabbit antithymocyte globulin induction and risk of post-transplant lymphoproliferative disease in adult and pediatric solid organ transplantation: An update

Lifetime Cost-Effectiveness of Calcineurin Inhibitor Withdrawal After De Novo Renal Transplantation

Early Outcomes of Thymoglobulin and Basiliximab Induction in Kidney Transplantation: Application of Statistical Approaches to Reduce Bias in Observational Comparisons

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