Thymoglobulin Dose Optimization for Induction Therapy in High Risk Kidney Transplant Recipients

Gurk-Turner, Cheryle; Airee, Richa; Philosophe, Benjamin; Kukuruga, Debra; Drachenberg, Cinthia B.; Haririan, Abdolreza

doi:10.1097/tp.0b013e31816dd596

Cited by 67 publications

(52 citation statements)

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“…Although the IBW cohort had a higher incidence of BPAR episodes than the TBW cohort, it was not statistically different and was comparable to previous studies. 4,5 The 2 cohorts were fairly well-matched in terms of age, sex, HLA antigen matching, and peak panel reactive antibody; however, some differences at baseline are of note. The total body weight of the IBW cohort was significantly higher than that of the TBW cohort (86.4 vs 75.7 kg; P = .008).…”

Section: Discussionmentioning

confidence: 99%

“…Patients who received > 7.5 mg/kg IBW (n = 63) had an overall 1-year incidence of BPAR episodes similar to patients who received ≤ 7.5 mg/kg IBW (n = 33) (8.8% vs 9.5%; P = .9). 4 The corresponding mean cumulative rATG doses were 10.3 mg/kg IBW versus 5.7 mg/kg IBW. When this study is compared with our results, it is important to note that some distinct differences in the patient population evaluated exist.…”

Section: Discussionmentioning

confidence: 99%

“…3 Initially, its efficacy was shown with induction regimens involving 8 to 11 mg/kg rATG; however, more recently, dosing strategies of 6 to 7.5 mg/kg rATG have demonstrated efficacy with an improved safety profile. 1,4,5 The most commonly used individual dose is 1.5 mg/kg of body weight, which is then repeated for 4 or 5 subsequent days. However, a pharmacokinetic study of rATG demonstrated that it does not distribute readily into adipose tissue, which has led to the question of whether regimens could be calculated using ideal body weight (IBW) rather than total body weight (TBW).…”

Section: Introductionmentioning

confidence: 99%

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Vacha

Gommer²,

Rege³

et al. 2016

Exp Clin Transplant

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Objectives: The optimal dose of rabbit antithymocyte globulin induction therapy in kidney transplant recipients with high immunologic risk lacks consensus. The purpose of this study was to evaluate the effect of using ideal body weight rather than total body weight for the weight-based dose calculations in this patient population. Materials and Methods: Data were retrospectively collected on 89 adult patients who received rabbit antithymocyte globulin induction therapy for high immunologic risk kidney transplant. Hospital protocol changed from the use of cumulative rabbit antithymocyte globulin doses of 7.5 mg/kg total body weight to 7.5 mg/kg ideal body weight in 2009. Patients were separated into 2 cohorts based on the amount of rabbit antithymocyte globulin (in mg/kg total body weight) received. Rate of biopsy-proven acute rejection, patient survival, and allograft function were evaluated at 90 days and 1 year after transplant. Cost of induction therapy was also evaluated. Results: Baseline demographics were predominantly similar between the 2 cohorts. No significant difference in maintenance immunosuppression was identified. Rates of biopsy-proven acute rejection at 90 days and 1 year were similar between ideal and total body weight cohorts (4.2% vs 0% at 90 days, P = .5; 8.7% vs 0% at 1 year, P = .13). Patient survival and allograft function were also similar. Median cost of rabbit antithymocyte globulin induction therapy per patient was lower in the ideal body weight cohort, but this difference was not statistically significant ($17 542 vs $19 934; P = .3). Conclusions: Our results suggest that use of ideal body weight for dose calculations of rabbit antithymocyte globulin induction therapy in high immunologic risk kidney transplant recipients at 7.5 mg/kg results in low rates of acute rejection with a safety profile similar to that shown with a total body weight dosage. Use of ideal body weight for lower cumulative doses may still need further evaluation in this patient population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Untitled

Vacha

Gommer²,

Rege³

et al. 2016

Exp Clin Transplant

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“…Работы последних лет продемонстрировали зна-чимые преимущества индукции антитимоцитар-ным иммуноглобулином по сравнению с плацебо или блокаторами рецептора IL2 при транспланта-ции почки пациентам высокого иммунологического риска [77][78][79]. Например, в 2015 году Hellemans et al сообщили о результатах пятилетнего наблюдения за реципиентами высокого иммунологического рис-ка (доля ретрансплантаций -70%), получавшими индукцию иммуносупрессии кроличьим антитимо-цитарным иммуноглобулином либо даклизумабом.…”

Section: индукция иммуносупрессииunclassified

Repeat Kidney Transplantation

Сушков

2017

RJTAO

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ФГБУ «Федеральный научный центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России, Москва, Российская Федерация В настоящее время для большинства пациентов с терминальной почечной недостаточностью пересад-ка почки является наилучшим методом заместительной почечной терапии (ЗПТ), который значительно увеличивает продолжительность и качество жизни. Прогресс в области органного донорства, хирурги-ческой техники, трансплантационной иммунологии и иммуносупрессии существенно улучшил непос-редственные результаты трансплантаций. При этом отдаленная выживаемость трансплантатов в течение последних двух десятилетий практически не изменилась. Несоответствие между показателями отдален-ной выживаемости реципиентов и трансплантатов привело к увеличению количества пациентов, утра-тивших функцию пересаженной почки. Для большинства из них повторная трансплантация представля-ется оптимальным вариантом продолжения ЗПТ, хотя и сопряжена c большей частотой осложнений. При этом рекомендации по проведению ретрансплантации почки, основанные на принципах доказательной медицины, до сих пор отсутствуют. Настоящий обзор основан на материале 100 научных публикаций, посвященных различным аспектам планирования и выполнения ретрансплантации почки. Nowadays, kidney transplantation is the best approach of renal replacement therapy for the majority of patients with end-stage renal disease that signifi cantly improves the quality and length of life. Advances in the fi eld of organ donation, immunosuppression, transplant surgery and immunology have improved short-term graft and patient survival. But the long-term graft survival remains static over last two decades. The disparity between low graft and high patient long-term survival led to increasing number of transplant recipients with failed grafts. Repeat renal transplant is presumed to be a good option for many patients losing their grafts, but it is associated with higher complication rates. Unfortunately, there are no evidence-based recommendations or guidelines for renal retransplantation procedure. This review is based on 100 scientifi c publications related to various aspects of the kidney retransplantation and provides the recent data on this matter. Key words: kidney transplantation, kidney retransplantation, graft failure, graft rejection, immunosuppression.Для корреспонденции: Сушков Александр Игоревич. Адрес: 123182, Москва, ул. Щукинская, д. ВВЕДЕНИЕВ течение последних десятилетий транспланта-ция почки остается оптимальным методом замес-тительной почечной терапии, обеспечивающим по сравнению с лечением диализом лучшую продол-жительность и качество жизни пациентов. По дан-ным актуального регистра ERA-EDTA, пятилетняя выживаемость пациентов при лечении гемо-или перитонеальным диализом составляет 40,6%, а пос-ле пересадки почки от живого или трупного доно-ра -94,3 и 87,1% соответственно [1]. Несмотря на столь впечатляющие результаты, следует признать, что функционирование трансплантата в течение 20 и более лет -ситуация скорее уникальная, чем обычная...

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“…32 Gurk-Turner and associates conducted a retrospective cohort study looking specifically at the optimal ATG dose in high-risk kidney transplant recipients in the United States between 2000 and 2005. 33 Patients were considered high risk if they had required retransplants or had a PRA > 40%. All patients received tacrolimus, MMF, and steroids.…”

Section: Studies Investigating the Optimal Antithymocyte Globulin Dosementioning

confidence: 99%

Untitled

Buttigieg

Julie

Sharma³

et al. 2016

Exp Clin Transplant

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Kidney transplant remains the best type of renal replacement therapy in most patients with end-stage kidney disease, even in those with high immunologic risk. Immunosuppression in these patients is regarded as more complex, owing to the higher risk of both acute and chronic rejection. The advent of induction immunosuppression has resulted in a lower incidence of acute rejection and consequently improved shortterm patient and allograft outcomes. Indeed, the use of these agents, especially in high-risk recipients, has become standard of care at most transplant centers. Transplant physicians are constantly faced with the challenge of estimating the recipients' immunologic risk and tailoring their immunosuppression ac cordingly. This review article aims to provide an up-to-date evaluation of the various studies available, which investigated the use of induction agents in kidney transplant, specifically in high-risk recipients. It evaluates the use of the most frequently used polyclonal antibody (rabbit antithymocyte globulin) versus the less commonly used monoclonal antibody alemtuzumab, superseded agents such as muromonab-CD3, and potentially emerging agents such as rituximab, bortezomib, and eculizumab. With this systematic review, we hope to inform the scientific community and facilitate this controversial decision through the implementation of robust scientific evidence.

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Thymoglobulin Dose Optimization for Induction Therapy in High Risk Kidney Transplant Recipients

Abstract: Our results suggest that in high risk kidney transplant recipients total rATG doses less than or equal to 7.5 mg/kg are safe and effective in achieving a low rate of AR and graft outcomes comparable to higher doses.

Cited by 67 publications

References 32 publications

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Repeat Kidney Transplantation

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