Thymoglobuline plus basiliximab a mixed cocktail to start?

Spagnoletti, Gionata; Salerno, Maria Paola; Calia, Rosaria; Romagnoli, Jacopo; Citterio, Franco

doi:10.1016/j.trim.2017.06.005

Cited by 5 publications

(10 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In fact, some centers have used dual-induction therapy without significant adverse events, namely with a protocol consisting of standard-dose interleukin-2 receptor antibody (ie, basiliximab or daclizumab) but reduced dose of ATG (eg, 1 mg/kg/day × 3 days 14 or 200 mg total dose over 3 days). 15 , 16 One pilot randomized study compared basiliximab (20 mg on day 0 and 4) and low-dose ATG (0.5 mg/kg/day × 7 days; n = 17) versus standard-dose ATG alone (2 mg/kg/day × 7 days; n = 16) in 33 high-risk kidney transplant recipients (maintenance therapy consisted of steroids, cyclosporin A, and azathioprine or mycophenolate mofetil). 17 At 6 months, patient and graft survival were similar between the 2 groups; however, the basiliximab and low-dose ATG group had fewer complications, such as fever, leukopenia, and cytomegalovirus reactivations, and lower costs (€3000 savings [$3300 USD]) compared to standard-dose ATG alone induction group.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Risk Factors, and Outcomes of Kidney Transplant Recipients Treated With Both Basiliximab and Antithymocyte Globulin

Jeong

Quinn

Lentine

et al. 2020

Can J Kidney Health Dis

View full text Add to dashboard Cite

Background: Kidney transplant recipients are given induction therapy to rapidly reduce the immune response and prevent rejection. Guidelines recommend that an interleukin-2 receptor antibody (basiliximab) be the first-line agent and that a lymphocyte-depleting agent (antithymocyte globulin [ATG]) be reserved for those at high immunologic risk. Objective: To determine the incidence, risk factors, and outcomes for patients who receive both basiliximab and ATG for induction compared to either agent alone. Design: Retrospective cohort study. Setting: We used the transplant electronic medical record at the University of Alberta Hospital in Edmonton, Canada. Patients/samples/participants: We included incident adult kidney transplant recipients from 2013 to 2018. Measurements: We measured baseline characteristics, type, and dose of induction therapy used, estimated glomerular filtration rate (eGFR) at 1-year posttransplant, and outcomes of all-cause graft failure, death-censored graft failure, all-cause mortality, and death with a functioning graft. Methods: Differences between induction groups were compared using chi-square test for categorical variables and Kruskal-Wallis tests for continuous variables. We performed multivariable logistic regression modeling with type of induction therapy as the dependent variable and the case-level factors as the predictors (adjusted odds ratio). We estimated the Kaplan-Meier failure functions and used log-rank tests to assess statistical significance of differences in unadjusted incidence across induction therapy types. We compared cumulative incidence functions using a Fine and Gray competing risk regression model. Results: In all, 430 kidney transplant recipients were followed for a mean of 3.9 years (standard deviation 1.5). Of these, 71% (n = 305) received basiliximab alone, 22% (n = 93) received ATG alone, and 7% (n = 32) received both basiliximab and ATG. After adjusting for age and sex, compared to the basiliximab alone group, patients were more likely to receive dual-induction therapy if they were sensitized (calculated panel reactive antibody ≥80%), had diabetes mellitus or peripheral vascular disease, or experienced delayed graft function. Compared to the ATG alone group, the dual-induction therapy group had worse graft function at 1 year (mean eGFR 42 vs. 59 mL/min/1.73 m2, P = .0008) and an increased risk of all-cause graft failure (31% vs. 13%, P = .02) and death-censored graft failure (16% vs. 4%, P = .03). Limitations: There is a risk of confounding by indication, as patients who received dual-induction therapy likely had worse outcomes due to the indication for dual-induction therapy (such as delayed graft function). Conclusions: In our study, 1 out of 10 recipients who were treated with basiliximab also received ATG for induction therapy. These patients experienced worse outcomes than those treated with ATG alone. Trial registration: Not applicable (cohort study).

show abstract

Section: Discussionmentioning

confidence: 99%

Incidence, Risk Factors, and Outcomes of Kidney Transplant Recipients Treated With Both Basiliximab and Antithymocyte Globulin

Jeong

Quinn

Lentine

et al. 2020

Can J Kidney Health Dis

View full text Add to dashboard Cite

show abstract

“…The dual induction therapy with ATG and the IL2rAb basiliximab, compared with ATG alone, results in a prolonged depletion, extended to 3 months post-transplant of CD25 cells that represent the alloantigen-stimulated effector T cells [ 34 , 35 , 36 , 37 , 38 , 39 ]. At the same time, the low dose of ATG applied in our protocol (maximum total dose of 3 mg/kg) is associated with a lower rate of rejection and viral infection than the standard regimen of ATG induction that adopts a total dose of 5 to 6 mg/kg, being of particular benefit to combined liver and kidney recipients at high risk of delayed graft function, which may not tolerate higher doses of ATG because of concerns about over-immunosuppression and concomitant risk of infections [ 34 , 35 , 36 , 37 , 38 , 39 ].…”

Section: Methodsmentioning

confidence: 99%

“…Achieving early and effective lymphocyte depletion with dual induction therapy may allow for the delayed introduction of calcineurin inhibitors, early withdrawal or complete avoidance of maintenance steroids, possible lower daily dosages of maintenance immunosuppressive agents, and reduced costs [ 34 , 35 , 36 , 37 , 38 , 39 ].…”

Section: Methodsmentioning

confidence: 99%

Predictors of Kidney Delayed Graft Function and Its Prognostic Impact following Combined Liver–Kidney Transplantation: A Recent Single-Center Experience

Vincenzi

Gaynor

Vianna

et al. 2022

JCM

View full text Add to dashboard Cite

Combined liver–kidney transplantation (CLKT) improves patient survival among liver transplant recipients with renal dysfunction. However, kidney delayed graft function (kDGF) still represents a common and challenging complication that can negatively impact clinical outcomes. This retrospective study analyzed the incidence, potential risk factors, and prognostic impact of kDGF development following CLKT in a recently transplanted cohort. Specifically, 115 consecutive CLKT recipients who were transplanted at our center between January 2015 and February 2021 were studied. All transplanted kidneys received hypothermic pulsatile machine perfusion (HPMP) prior to transplant. The primary outcome was kDGF development. Secondary outcomes included the combined incidence and severity of developing postoperative complications; development of postoperative infections; biopsy-proven acute rejection (BPAR); renal function at 1, 3, 6, and 12 months post-transplant; and death-censored graft and patient survival. kDGF was observed in 37.4% (43/115) of patients. Multivariable analysis of kDGF revealed the following independent predictors: preoperative dialysis (p = 0.0003), lower recipient BMI (p = 0.006), older donor age (p = 0.003), utilization of DCD donors (p = 0.007), and longer delay of kidney transplantation after liver transplantation (p = 0.0003). With a median follow-up of 36.7 months post-transplant, kDGF was associated with a significantly increased risk of developing more severe postoperative complication(s) (p < 0.000001), poorer renal function (particularly at 1 month post-transplant, p < 0.000001), and worse death-censored graft (p = 0.00004) and patient survival (p = 0.0002). kDGF may be responsible for remarkable negative effects on immediate and potentially longer-term clinical outcomes after CLKT. Understanding the important risk factors for kDGF development in CLKT may better guide recipient and donor selection(s) and improve clinical decisions in this increasing group of transplant recipients.

show abstract

“…The association with highly sensitized recipients (calculated panel reactive antibody [cPRA] ≥80%) was stronger with ATG-alone induction than with dual induction therapy (aOR 4.61 4.92 5.24 versus 1.69 1.92 2. 19 ).…”

Section: Correlates Of Dual Induction Therapymentioning

confidence: 99%

“…12,16,19,21 This may be a useful strategy for older recipients, who often receive kidneys from older donors and are at high risk of delayed graft function but may not tolerate standard-dose ATG induction because of concerns about overimmunosuppression. 18,19 Also, achieving early and effective lymphocyte depletion with dual induction therapy A FIGURE 3. Kaplan-Meier cumulative incidence of death and failure according to type of induction therapy at 1 posttransplant and (B) 5 y posttransplant.…”

Section: Continued Next Pagementioning

confidence: 99%

Clinical Correlates and Outcomes of Dual Basiliximab and Antithymocyte Globulin Induction in Kidney Transplant Recipients: A National Study

Lam

Jeong

Quinn

et al. 2021

Transplantation Direct

View full text Add to dashboard Cite

show abstract

Thymoglobuline plus basiliximab a mixed cocktail to start?

Cited by 5 publications

References 4 publications

Incidence, Risk Factors, and Outcomes of Kidney Transplant Recipients Treated With Both Basiliximab and Antithymocyte Globulin

Incidence, Risk Factors, and Outcomes of Kidney Transplant Recipients Treated With Both Basiliximab and Antithymocyte Globulin

Predictors of Kidney Delayed Graft Function and Its Prognostic Impact following Combined Liver–Kidney Transplantation: A Recent Single-Center Experience

Clinical Correlates and Outcomes of Dual Basiliximab and Antithymocyte Globulin Induction in Kidney Transplant Recipients: A National Study

Contact Info

Product

Resources

About