Low-dose induction immunosuppression in deceased donor kidney transplantation during coronavirus disease pandemic - A multicentric prospective observational study

George, Jacob; Gracious, Noble; Gopal, Anjana; Balan, Satish; Murlidharan, Praveen; Gopalakrishnan, Sreedas; Potty, Vasudevsan; Kurup, Satheesh

doi:10.4103/ijot.ijot_111_20

Cited by 2 publications

(7 citation statements)

References 24 publications

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“…This suggests efficacy of even a single dose of ATG with suppression of CD3 and CD4 lymphocyte count with 1 mg/ kg of ATG for upto 4-7 days. Others have also reported similar results with a lesser occurrence of AMR and lymphocyte counts being supressed in the majority by day 3 with even for 5 days in some [9]. This could suggest that daily doses of ATG for upto 7 days may not be essential if there is adequate lymphocyte suppression.…”

Section: Can a Reduced Dose And Frequency Of Induction Immunosuppress...mentioning

confidence: 58%

“…If they are suppressed following the initial dose, subsequent doses of ATG could be deferred till the counts normalize. Titrating further doses of ATG based on lymphocyte count alone in the absence of monitoring facilities for CD lymphocyte counts with further doses of ATG given only if absolute lymphocyte count exceeded 750/μL has also been reported [9]. This may result in a lesser number of ATG doses and a lesser cumulative dose of ATG needed [51].…”

Section: Can a Reduced Dose And Frequency Of Induction Immunosuppress...mentioning

confidence: 98%

“…A higher degree of immunosuppression theoretically reduces the chance of rejection. However, this increases the risk of opportunistic infections, metabolic side effects as well as significantly raises the cost [7][8][9].…”

Section: Immunosuppression In Renal Transplantationmentioning

confidence: 99%

“…It may be possible to combine induction agents acting at different sites. ATG targets T cells and as Rituximab targets B cells, there may be a role in combining both [9,21,22]. Though a combination of ATG and IL2Ra has not been recommended [12], there are reports of combining ATG or IL2RA with rituximab in selected patients [9,21,22].…”

Section: Can Induction Agents Be Combined?mentioning

confidence: 99%

“…As Rituximab targets B cells and has been used in the management of antibody mediated rejections, there could be a role of combining it with a T cell depleting agent or IL2RA. There are reports on its use as an induction agent in combination with ATG or IL2RA albeit with differing doses and frequency [9,21,28].…”

Section: Can Induction Agents Be Combined?mentioning

confidence: 99%

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Perspective Chapter: Low Cost Immunosuppressive Strategies in Renal Transplantation

George¹

2023

Immunosuppression and Immunomodulation

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Renal transplantation is the treatment modality of choice in end stage renal disease. However, in low economic countries where government or insurance funding is not available, several patients do not opt for this treatment due to financial constraints. However, there could be options of tailored immunosuppression in both initial intensive induction immunosuppression and subsequent maintenance immunosuppression and immunomodulation thereby making this modality of treatment more cost effective. This could include selective use of induction agents, lesser frequency and dosing, use of cheaper induction agents and their combination, monitoring to decide the minimal dosage and frequency required and cost effective maintenance immunosuppressive agents with dose adjustment based on blood levels.

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Section: Can a Reduced Dose And Frequency Of Induction Immunosuppress...mentioning

confidence: 58%

Section: Can a Reduced Dose And Frequency Of Induction Immunosuppress...mentioning

confidence: 98%

Section: Immunosuppression In Renal Transplantationmentioning

confidence: 99%

Section: Can Induction Agents Be Combined?mentioning

confidence: 99%

Section: Can Induction Agents Be Combined?mentioning

confidence: 99%

See 3 more Smart Citations

Perspective Chapter: Low Cost Immunosuppressive Strategies in Renal Transplantation

George¹

2023

Immunosuppression and Immunomodulation

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Incidence of COVID-19 and Identification of Possible Risk Factors Associated with COVID-19 in Acute Renal Transplant Recipients in Pakistan

et al. 2022

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Background Renal transplant recipients are susceptible to increased mortality with COVID-19 infection. There is insufficient data regarding risk factors for COVID-19 disease acquisition. We aimed to identify them here. Material/Methods We enrolled Pakistani renal transplant recipients from February 10, 2020, to March 18, 2021, and actively tracked their baseline health status, transplant characteristics, comorbidities, immunosuppressive therapies, and post-transplant follow-ups until September 2021. Furthermore, we formulated 2 questionnaires for their compliance assessment with COVID-19-preventive measures. We also identified COVID-19 disease acquisition, symptomatology, and management. Results Among the 50 enrolled patients, 14 (28%) patients developed COVID-19, which is higher than the incidence observed in general Pakistani population (0.55%). Their mean age was 35.38 years ±11.69 SD years, and 82% of patients were males. The following factors were independently associated with COVID-19 disease: female gender ( P value: 0.042), diabetes mellitus ( P value: 0.002), anti-thymocyte globulin (ATG) induction ( P value: 0.006), in-person follow-ups ( P value: 0.000), prolonged immediate and late post-transplant hospital stays ( P value: 0.019 and 0.000, respectively), raised post-transplant serum creatinine ( P value: 0.019), and COVID-19 protective measures non-compliance ( P value: 0.000). Out of 14 infected recipients, 92.85% required symptomatic management and overall mortality was 0%. Conclusions Female gender, diabetes mellitus, ATG induction, in-person follow-ups, prolonged hospital stays, raised post-transplant serum creatinine, and COVID-19-protective measures non-compliance were associated with the higher acquisition of SARS-CoV-2 infection. By taking concrete measures against these risk factors, we can continue renal transplants, as overall mortality was lower than in the general Pakistani population (2%).

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Low-dose induction immunosuppression in deceased donor kidney transplantation during coronavirus disease pandemic - A multicentric prospective observational study

Cited by 2 publications

References 24 publications

Perspective Chapter: Low Cost Immunosuppressive Strategies in Renal Transplantation

Perspective Chapter: Low Cost Immunosuppressive Strategies in Renal Transplantation

Incidence of COVID-19 and Identification of Possible Risk Factors Associated with COVID-19 in Acute Renal Transplant Recipients in Pakistan

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