Association between cumulative rATG induction doses and kidney graft outcomes and adverse effects in kidney transplant patients: a systematic review and meta-analysis

Mohammadi, Keyhan; Khajeh, Behrouz; Dashti‐Khavidaki, Simin; Shab‐Bidar, Sakineh

doi:10.1080/14712598.2021.1960978

Cited by 3 publications

(3 citation statements)

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“…Previous studies have shown rATG >6 mg/kg to be associated with higher rates of infection, such as that of CMV and BK viremia, and cytopenia. 8 These patients were also concurrently on other immunosuppressants and cytopenia-inducing agents posttransplant. Cytopenia was further analyzed between patients receiving ≤4.5 mg/kg and >4.5 mg/kg rATG.…”

Section: Discussionmentioning

confidence: 99%

“…Dose-ranging studies have found cumulative rATG dose ≤6 mg/kg to be effective in preventing kidney transplant rejection while minimizing cytopenia and infection. 8 However, no available literature specifically evaluates rATG optimal dosing in DGF. A recent systematic review and meta-analysis of kidney recipients demonstrated cumulative rATG dose of ≤4.5 mg/kg to be correlated with significantly less BPAR at 6% per patient-years, compared to 12% in >4.5 mg/kg to 6 mg/kg and 16% in >6 mg/kg.…”

Section: Introductionmentioning

confidence: 99%

“…A recent systematic review and meta-analysis of kidney recipients demonstrated cumulative rATG dose of ≤4.5 mg/kg to be correlated with significantly less BPAR at 6% per patient-years, compared to 12% in >4.5 mg/kg to 6 mg/kg and 16% in >6 mg/kg. 8 This analysis failed to distinguish induction therapy from rejection treatment as part of cumulative rATG dose and did not adjust for patient-specific rejection risk factors. Rates of cytomegalovirus (CMV) and BK viremia were lower with cumulative doses of ≤4.5 mg/kg, while the incidence of graft loss and DGF showed no dose-response correlation.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Cumulative 6 mg/kg Antithymocyte Globulin on Early Posttransplant Outcomes in Kidney Transplant Recipients with Delayed Graft Function

Vu,

Bhayana,

Sweiss

et al. 2024

Prog Transpl

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Introduction: Delayed graft function in kidney transplant is associated with an increased risk of rejection and graft loss. Use of rabbit antithymocyte globulin induction in delayed graft function has been correlated with less rejection compared to basiliximab, but optimal dosing remains unknown. Program Evaluation Aims: The purpose of this evaluation was to retrospectively assess the short-term effectiveness and tolerability of a clinical protocol that increased the net state of immunosuppression in delayed graft function kidney transplant recipients using cumulative 6 mg/kg rabbit antithymocyte globulin induction. Design: This retrospective cohort included 88 kidney transplant recipients with delayed graft function, transplanted between January 2017 and March 2021, who either received cumulative 4.5 mg/kg pre-protocol or 6 mg/kg post-protocol rabbit antithymocyte globulin. Outcomes evaluated were biopsy-proven acute rejection and incidence of graft loss, infection, and cytopenia at 6 months. Results: A significant reduction of biopsy-proven acute rejection incidence occurred post-protocol implementation (10/33, 30.3% vs 6/55, 10.9%; P = .04). Of those with rejection, significantly less post-protocol patients were classified as acute cellular rejection (9/10, 90.0% vs 2/6, 33.3%; P = .04). No death-censored graft loss was observed in either group. Rates of cytopenia and infection were similar pre- versus post-protocol implementation. Conclusion: Increasing the exposure to rabbit antithymocyte globulin and maintenance immunosuppression in delayed graft function kidney transplant recipients was tolerable and significantly reduced rejection occurrence at 6 months.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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