Polyclonal anti T-lymphocyte antibody therapy monitoring in kidney transplant recipients: comparison of CD3+ T cell and total lymphocyte counts

Abstract

Objective:To investigate the correlation between total lymphocyte and CD3+ T cell counts in peripheral blood in renal transplant patients treated with anti-thymocyte globulin, and discuss related outcomes.Methods:A single-center, retrospective study involving 226 patients submitted to kidney transplant between 2008 and 2013, and treated with anti-thymocyte globulin for induction or treatment of cellular rejection. Doses were adjusted according to CD3+ T cell or total lymphocyte counts in peripheral blood.Results:A total of 664 paired samples were analyzed. The Spearman's correlation coefficient was 0.416 (p<0.001) for all samples combined; the overall Kappa coefficient was 0.267 (p<0.001). Diagnostic parameters estimated based on total lymphocyte counts were also calculated using the number of CD3+ T cells (gold standard), with a cut off of >20 cells/mm3.Conclusion:Total lymphocyte and CD3+ T cell counts in peripheral blood are not equivalent monitoring strategies in anti-thymocyte globulin therapy.

COVID‐19 pneumonia in kidney transplant recipients: Focus on immunosuppression management

“…by the commonly adopted practice of absolute lymphocyte count monitoring as an effective marker for therapeutic response to antithymocyte globulin during induction for transplant. [9][10][11][12] Although the exact pathogenesis of COVID-19 remains to be elucidated, the innate immune system has been widely accepted as a crucial player in the initial stages of infection. Combined with prototypical type I interferons (IFN) produced by any virally infected cells, IFN-gamma is produced by activated T-lymphocytes, stimulating innate macrophage-mediated immunity as the first line of defense against viral infections.…”

“…Our center experience of withholding calcineurin inhibitors and antimetabolite during the inpatient management of COVID‐19 pneumonia did not increase the risk of allograft rejection in the 30 patients included in this cohort. Profound lymphopenia—a drastic decrease in absolute lymphocyte count on admission compared to normal baseline values—was noted in most patients and suggests minimal risk of acute rejection, evidenced by the commonly adopted practice of absolute lymphocyte count monitoring as an effective marker for therapeutic response to anti‐thymocyte globulin during induction for transplant 9‐12 …”

Comparison of clinical outcome of induction immunosuppressive therapy with thymoglobulin and standard therapy in kidney transplantation; a randomized double-blind clinical trial

“…One of the important issues is that the success rate of the transplant depends entirely on receiving immunosuppressive therapies. In recent years, an induction immunosuppressive regimen has been administered extensively in many transplantation centers (8). Thymoglobulin has not been approved by the Food and Drug Administration (FDA) for kidney transplantation yet.…”

“…Monoclonal and polyclonal antibodies are administrated for induction therapy with different therapeutic protocols (7). Thymoglobulin is a lymphocyte depleting polyclonal antibody and is used as an induction therapy to reduce the acute rejection of allograft (8). There is no consensus on the appropriate dosage and duration of treatment.…”

Ideal Body Weight-Based Dosing of Rabbit Antithymocyte Globulin for Cost Minimization in Kidney Transplantation

“…8 Another strategy employed T-cell count monitoring to guide recurrent rATG doses, whereby rATG was given only when counts surpass a certain threshold. 9 The lack of rATG distribution into adipose tissue may allow for leveraging the pharmacokinetic profile by using ideal body weight (IBW)-based dosing, thereby reducing cumulative exposure. This approach may be particularly sensible in the setting of increasing rates of obesity in the transplant population.…”