Low dose rabbit antithymocyte globulin is non-inferior to higher dose in low-risk pediatric kidney transplant recipients

Efficacy and safety of single‐dose anti‐thymocyte globulin versus basiliximab induction therapy in pediatric kidney transplant recipients: A retrospective comparative cohort study

“…The single dose of 3 mg/kg of r‐ATG is lower than the usual dose, and yet it was associated with a higher 12‐month acute rejection‐free survival than BAS. This is consistent with other recent studies that found no increase in the rejection rate when comparing low doses of ATG with standard doses in the pediatric population of low‐risk kidney recipients 16,26 …”

“…This is consistent with other recent studies that found no increase in the rejection rate when comparing low doses of ATG with standard doses in the pediatric population of lowrisk kidney recipients. 16,26 The combination of tacrolimus, mycophenolate, and prednisone is considered the standard of care for kidney transplant recipients in most centers. 3,27,28 The use of azathioprine as part of our standard adverse events and the higher incidence of CMV infection/disease, especially in the absence of pharmacological prophylaxis for CMV, which can lead to premature discontinuation of the drug.…”

“…The use of r‐ATG has consistently shown higher efficacy for the prevention of acute rejection compared to anti‐IL‐2R monoclonal antibodies, 8–11 but concerns still exist regarding the increased risk of infections and cancer, especially at the initial doses of 1–1.5 mg/kg over 7–10 days 12–14 . However, recent studies have demonstrated that lower doses of r‐ATG may be safer without loss of efficacy, including the use of a single dose 15–18 …”

“…[12][13][14] However, recent studies have demonstrated that lower doses of r-ATG may be safer without loss of efficacy, including the use of a single dose. [15][16][17][18] Recently, a natural experiment conducted in our center demonstrated that, in adult kidney transplant recipients, the use of a single 3 mg/Kg r-ATG dose was associated with an 81% lower risk of acute rejection, without an increase in the risk of CMV infection compared to no induction. 19 Typically, pediatric kidney transplant recipients receive induction therapy with anti-IL-2R monoclonal antibodies.…”