Thymoglobulin Versus ATGAM Induction Therapy in Pediatric Kidney Transplant Recipients: A Single-Center Report

Khositseth, Sookkasem; Matas, Arthur J.; Cook, Marie; Gillingham, Kristen J.; Chavers, Blanche M.

doi:10.1097/01.tp.0000158325.12837.a2

Cited by 41 publications

(33 citation statements)

References 18 publications

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“…A single retrospective pediatric study demonstrated that muromonab-CD3 (OKT3) and equine antithymocyte globulin (ATG) (ATGAM, Upjohn, USA) were equally effective in reversing CRR [4], though no further comparative studies have been conducted in children. Thymoglobulin, a polyclonal rabbit ATG preparation shown to be associated with fewer episodes of acute rejection than with ATGAM when used as induction therapy, has been the most commonly used antilymphocyte preparation in recent years [5]. Following improvements in immunosuppression protocols over the last decade, there has been a substantial reduction in the incidence of acute allograft rejection.…”

Section: Introductionmentioning

confidence: 99%

Antithymocyte treatment of steroid-resistant acute rejection in renal transplantation

et al. 2011

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To evaluate the outcome of early (ER <3 months) and late (LR >3 months) episodes of corticosteroid resistant acute allograft rejection (CRR) treated with anti-thymocyte globulin (ATG) in pediatric renal allograft recipients. Retrospective study of 15 children, mean age 13.2y, who received ATG for the treatment of biopsy proven CRR over a 15 year period. Seven children received ATG for ER (median 26 days post transplantation) and 8 for LR (median 763 days). There was a significant improvement in the 3 month eGFR (70.3 ml/min/1.73m 2 , SD 22.3, p=0.018) when compared with the value prior to ATG treatment (23.3 ml/min/1.73m 2 , SD 10.2) in the ER group. In the LR group (4 DSA positive) there was no improvement in the eGFR at 3 months (42 ml/min/1.73m 2 , SD 10.5, p=0.32) when compared with the value prior to ATG (38 ml/min/ 1.73m 2 , SD 9.7). At final review, eGFR in the ER group was 72.3 ml/min/1.73m 2 (SD 33) vs. 37.7 ml/min/1.73m 2 (SD 17.9) in the LR group after a mean follow up of 10.4y and 1.2y, respectively. ATG therapy in CRR is associated with reversal of rejection and excellent graft outcome in children with ER. The benefits remain uncertain in LR, the etiology of which is multifactorial.

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Section: Introductionmentioning

confidence: 99%

Antithymocyte treatment of steroid-resistant acute rejection in renal transplantation

et al. 2011

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“…[12][13][14][15] On the other hand, studies of ATG-F have reported mixed results. 2,16 Notwithstanding these contradictory findings, we could not find significant differences, except for the WBC count at month 1, between the 2 drugs.…”

Section: Discussionmentioning

confidence: 91%

Clinical Experience With Thymoglobulin and Antithymocyte Globulin-Fresenius as Induction Therapy in Renal Transplant Patients: A Retrospective Study

Cicora

Mos

Paz³

et al. 2013

Exp Clin Transplant

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Objectives: We describe our experiences with, and compare the outcomes of, 2 groups of renal transplant patients treated with thymoglobulin or antithymocyte globulin-Fresenius as induction therapy at transplant to reduce the incidence of acute rejection and prevent delayed allograft function. Materials and Methods: Twenty-four recipients of deceased-donor or living-donor kidney transplants received thymoglobulin, and 23 patients received antithymocyte globulin-Fresenius. Patient and graft survival and efficacy and safety were assessed at 3 months. Results: The demographic characteristics of both groups were comparable, but the predominant donor type was significantly different. Incidence of complications, delayed graft function, and creatinine concentrations were comparable in both groups. At 3 months after the transplant, patient survival rate was 92% in the thymoglobulin group and 96% in the antithymocyte globulinFresenius group (P > .05), and death-censored graft survival rate for both groups was not significantly different. Average hematocrit and lymphocyte, neutrophil, and platelet counts were comparable in both groups at 3 months' follow-up. Average white blood count at 1 month was significantly different between the groups: at 5.62 ± 2.45 × 10 3 cells/mm 3 in the thymoglobulin group and 7.85 ± 4.10 × 10 3 cells/mm 3 in the ATG-F group (P < .05). Conclusions: Considering the study design limitations, we observed that our group of treated patients, safety, and efficacy of thymoglobulin and antithymocyte globulin-Fresenius were generally comparable.

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“…Two retrospective studies evaluated the relative efficacy of no induction and induction with rATG, eATG, or basiliximab in pediatric patients also receiving combination immunosuppressive therapy. 35,36 The first of the studies, by Khositseth et al, compared rATG 1.5 mg/kg/day for 10 days with eATG 15 mg/kg/day for 14 days in subjects receiving concomitant corticosteroids, cyclosporine, and mycophenolate mofetil. 36 Khositseth et al found that rATG induction was associated with significantly lower rates of BCAR (33% versus 50%, P=0.02) up to 3 years after transplantation in these patients.…”

Section: Special Populations Pediatric Renal Transplant Recipientsmentioning

confidence: 99%

“…35,36 The first of the studies, by Khositseth et al, compared rATG 1.5 mg/kg/day for 10 days with eATG 15 mg/kg/day for 14 days in subjects receiving concomitant corticosteroids, cyclosporine, and mycophenolate mofetil. 36 Khositseth et al found that rATG induction was associated with significantly lower rates of BCAR (33% versus 50%, P=0.02) up to 3 years after transplantation in these patients. Median time to BCAR and severity of BCAR were not significant between the treatment groups, …”

Section: Special Populations Pediatric Renal Transplant Recipientsmentioning

confidence: 99%

“…35 Both studies suggest that rATG induction is relatively well tolerated in pediatric patients. 35,36 There was no difference in incidence of cytomegalovirus infection or post-transplant lymphoproliferative disorder between rATG, eATG, or basiliximab induction, or without induction. 36 However, there was a significantly increased likelihood of Epstein-Barr virus infection with rATG induction than with eATG induction (8% versus 3%, respectively, P=0.002).…”

mentioning

confidence: 94%

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Rabbit anti-thymocyte globulin induction in renal transplantation: review of the literature

Andress¹,

Gupta²,

Siddiqi³

et al. 2014

TRRM

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Rabbit anti-thymocyte globulin (rATG) has proven benefit as induction therapy in renal transplant recipients, achieving reduced acute rejection rates and better short-term allograft function, with slightly higher rates of complications such as infections and malignancy. Compared with other agents, the most benefit from rATG induction has been observed in renal transplant recipients at high immunologic risk for rejection. However, in special populations, such as pediatrics, the elderly, and hepatitis C-positive and human immunodeficiency virus-positive renal transplant recipients, additional information is needed to delineate the absolute benefit of rATG induction compared with other induction agents. Selection of rATG as the choice of induction therapy in renal transplant recipients should be guided by a cost-effective approach in balancing efficacy, safety, and cost. This review summarizes the published literature on efficacy, safety, and cost of rATG induction in renal transplantation.

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Thymoglobulin Versus ATGAM Induction Therapy in Pediatric Kidney Transplant Recipients: A Single-Center Report

Abstract: Thus, Thymoglobulin induction was associated with a decreased incidence of acute rejection and an increased incidence of EBV infection in pediatric KTx recipients. EBV monitoring should be performed in EBV-naive recipients receiving Thymoglobulin.

Cited by 41 publications

References 18 publications

Antithymocyte treatment of steroid-resistant acute rejection in renal transplantation

Antithymocyte treatment of steroid-resistant acute rejection in renal transplantation

Clinical Experience With Thymoglobulin and Antithymocyte Globulin-Fresenius as Induction Therapy in Renal Transplant Patients: A Retrospective Study

Rabbit anti-thymocyte globulin induction in renal transplantation: review of the literature

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