Leukocyte response to thymoglobulin or Atgam for induction immunosuppression in a randomized, double-blind clinical trial in renal transplant recipients

Brennan, Daniel C.; Flavin, Karen; Lowell, Jeffrey A.; Howard, Todd K.; Shenoy, Surendra; Burgess, S. E. P.; Dolan, Sara; Kano, J.M; Mahon, M; Schnitzler, Mark A.; Woodward, Robert S.; Irish, William; Ramachamdra, V; Singer, Gary G.

doi:10.1016/s0041-1345(99)00096-2

Cited by 20 publications

(11 citation statements)

References 5 publications

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“…Most of the studies in which peripheral lymphocyte subsets have been analyzed included very few patients and observation period hardly lasted 1 year (3)(4)(5)(6). In a 5-year study in 43 patients, the changes in lymphocyte subsets seemed similar to those we report, either for CD4 and CD8 cells (7).…”

supporting

confidence: 70%

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Long-term Kinetic of T-lymphocyte Subsets in Kidney-Transplant Recipients: Influence of Anti–T-cell Antibodies and Association with Posttransplant Malignancies

et al. 2005

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A low CD4 lymphocyte count has been associated with skin and nonskin cancers in kidney transplant recipients (KTR) and might be a useful prediction tool. We analyzed the serial measurements of CD4 and CD8 lymphocytes to study the influence of immunosuppressants and look for a possible predictive value of lymphocyte count for the occurrence of cancer. In 250 successive KTR, blood lymphocytes were labeled for CD4 and CD8 count, prior transplantation, at month 3 and 6 and each year thereafter, throughout a 10-year observation period. The kinetics of lymphocyte subsets were compared in regard to treatments, cancer and confounding factors. ATG were responsible of an early and long lasting impairment in CD4 cells. Patients with a cancer and especially those with multiple tumors, presented with less CD4 cells throughout the observation period, but ATG were not directly associated to the occurrence of tumors. An early low CD4 count was of poor predictive value for the occurrence of cancer.

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supporting

confidence: 70%

“…Depletion of peripheral T cells by antilymphocyte globulins has been known for long (11). More recently, treatments with ATG have been compared to triple therapy (6) and to OKT3 (7), or various antilymphocyte preparations together (5). The depletion of CD4 lymphocytes was a constant finding.…”

mentioning

confidence: 99%

Long-term Kinetic of T-lymphocyte Subsets in Kidney-Transplant Recipients: Influence of Anti–T-cell Antibodies and Association with Posttransplant Malignancies

et al. 2005

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“…Given that HIVinduced CD4+ T-cell depletion predisposes patients to opportunistic and select nonopportunistic infections, there is concern that thymoglobulin-induced CD4+ T-cell depletion may similarly predispose HIV-infected transplant recipients to greater infection risk. Indeed, in patients without HIV, thymoglobulin produces lymphocyte depletion for as long as 2 years, and may deplete the CD4+ T-cell count for even longer (6)(7)(8). Such depletion is associated with increased risk of infection (9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Thymoglobulin-Associated Cd4+ T-Cell Depletion and Infection Risk in HIV-Infected Renal Transplant Recipients

Carter¹,

Melcher²,

Carlson³

et al. 2006

American Journal of Transplantation

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HIV-infected patients are increasingly referred for kidney transplantation, and may be at an increased risk for rejection. Treatment for rejection frequently includes thymoglobulin. We studied thymoglobulin's effect on CD4+ T-cell count, risk of infection and rejection reversal in 20 consecutive HIV-infected kidney recipients. All patients used antiretroviral therapy and opportunistic infection prophylaxis. Maintenance immunosuppression consisted of prednisone, mycophenolate mofetil and cyclosporine. Eleven patients received thymoglobulin (7 for rejection and 4 for delayed/slow graft function) while 9 did not. These two groups were similar in age, gender, race, donor characteristics and immunosuppression. Mean CD4+ T-cell counts remained stable in patients who did not receive thymoglobulin, but became profoundly suppressed in those who did, decreasing from 475 ± 192 to 9 ± 10 cells/lL (p < 0.001). Recovery time ranged from 3 weeks to 2 years despite effective HIV suppression. Although opportunistic infections were successfully suppressed, low CD4+ T-cell count was associated with increased risk of serious infections requiring hospitalization. Rejection reversed in 6 of 7 patients receiving thymoglobulin. We conclude that thymoglobulin reverses acute rejection in HIV-infected kidney recipients, but produces profound and long-lasting suppression of the CD4+ T-cell count associated with increased risk of infections requiring hospitalization.

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“…There are no current practice guidelines for management of PTN in kidney transplant recipients, and PTN or leukopenia has been reported with many transplant medications to include anti-lymphocyte globulin (4), thymoglobulin (5,6), azothioprine (4,(7)(8)(9), mycophenolate (10), sirolimus (11), valacyclovir (12), valgancyclovir (13), and trimethoprimsulfamethoxazole (14). Generally, the above medications are not given individually, and cytopenias have been reported from various combinations (12,14) of medications, possibly related to idiosyncratic drug-drug interactions.…”

mentioning

confidence: 99%

Poor Outcomes Associated With Neutropenia After Kidney Transplantation: Analysis of United States Renal Data System

et al. 2011

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Leukocyte response to thymoglobulin or Atgam for induction immunosuppression in a randomized, double-blind clinical trial in renal transplant recipients

Cited by 20 publications

References 5 publications

Long-term Kinetic of T-lymphocyte Subsets in Kidney-Transplant Recipients: Influence of Anti–T-cell Antibodies and Association with Posttransplant Malignancies

Long-term Kinetic of T-lymphocyte Subsets in Kidney-Transplant Recipients: Influence of Anti–T-cell Antibodies and Association with Posttransplant Malignancies

Thymoglobulin-Associated Cd4+ T-Cell Depletion and Infection Risk in HIV-Infected Renal Transplant Recipients

Poor Outcomes Associated With Neutropenia After Kidney Transplantation: Analysis of United States Renal Data System

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