CMV infections after two doses of daclizumab versus thymoglobulin in renal transplant patients receiving mycophenolate mofetil, steroids and delayed cyclosporine A

Abou-Ayache, Ramzi; Büchler, Mathias; Lepogamp, Patrick; Westeel, Pierre-François; Meur, Yann Le; Étienne, Isabelle; Lobbedez, Thierry; Toupance, Olivier; Caillard, Sophie; Goujon, Jean-Michel; Bergougnoux, L.; Touchard, Guy

doi:10.1093/ndt/gfm873

Cited by 47 publications

(59 citation statements)

References 33 publications

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“…The incidence of DGF and BPAR was similar in both groups. Similar findings were reported in another multicentre prospective study by Abou-Ayache et al [47]. …”

Section: Role Of Thymoglobulin In Prevention Of Delayed Graft Functiosupporting

confidence: 92%

“…No difference in the incidence of CMV infection was seen between these groups. This result was supported by another multicentred RCT which showed no difference in the incidence of CMV infection/syndrome/disease at 1 year, although the mean number of pp65-positive cells was lower in the daclizumab group [47]. However, this trial used a cyclosporine-based maintenance immunosuppression regimen.…”

Section: Interleukin-2 Receptor Antibody Versus Thymoglobulin In Renamentioning

confidence: 69%

“…Patients and graft survivals and the incidence of biopsy-proven acute rejection (BPAR) were also identical [47]. …”

Section: Thymoglobulin and Infectious Complicationsmentioning

confidence: 99%

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Thymoglobulin and Its Use in Renal Transplantation: A Review

2013

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Thymoglobulin (Thymoglobulin®; Genzyme, Cambridge, Mass., USA) is a polyclonal antibody which has been used in the field of transplantation over the last four decades. With an initial hesitancy, it is widely used now in the prevention and treatment of rejection following renal transplantation. Thymoglobulin's lack of nephrotoxic properties (unlike calcineurin inhibitors) may potentiate it to be a very useful induction therapy during the early days following transplantation, particularly in a donation after circulatory death programme. More recently its role in conjunction with inhibitors of terminal complement activation has been shown to be beneficial in cross-match-positive transplantation. This review article consolidates up-to-date available evidence to address the therapeutic role of thymoglobulin in immunological tolerance, ischemia perfusion, live donor transplantation, delayed graft function, prevention and treatment of rejection, graft survival and post-transplant lymphoproliferative disorder following renal transplantation.

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“…The incidence of DGF and BPAR was similar in both groups. Similar findings were reported in another multicentre prospective study by Abou-Ayache et al [47]. …”

Section: Role Of Thymoglobulin In Prevention Of Delayed Graft Functiosupporting

confidence: 92%

Section: Interleukin-2 Receptor Antibody Versus Thymoglobulin In Renamentioning

confidence: 69%

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Thymoglobulin and Its Use in Renal Transplantation: A Review

2013

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“…Several studies have shown that the incidence of allograft rejection in these patients can be lowered with an induction treatment with ATGs +/- IVIG with an incidence of about 11–15% of clinical rejections [4;22]. Also we observed an overall low incidence of clinical allograft rejection (AMR and TCMR) in only 15% of our patients during the first 24 months after transplantation.…”

Section: Discussionsupporting

confidence: 48%

A Comparison of Two Types of Rabbit Antithymocyte Globulin Induction Therapy in Immunological High-Risk Kidney Recipients: A Prospective Randomized Control Study

et al. 2016

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BackgroundInduction treatment with rabbit polyclonal antithymocyte globulins (ATGs) is frequent used in kidney transplant recipients with donorspecific HLA antibodies and shows acceptable outcomes. The two commonly used ATGs, Thymoglobulin and ATG-F have slightly different antigen profile and antibody concentrations. The two compounds have never been directly compared in a prospective trial in immunological high-risk recipients. Therefore we performed a prospective randomized controlled study comparing the two compounds in immunological high-risk kidney recipients in terms of safety and efficacy.MethodsImmunological high-risk kidney recipients, defined as the presence of HLA DSA but negative CDC-B and T-cell crossmatches were randomized 1:1 to receive ATG-F or Thymoglobulin. Maintenance immunosuppressive therapy consisted of tacrolimus, mycophenolate mofetil and steroids.ResultsThe per-protocol analysis included 35 patients. There was no immediate infusion reaction observed with both compounds. No PTLD or malignancy occurred during the follow-up in both groups. The incidence of viral and bacterial infections was similar in both groups (p = 0.62). The cumulative incidence of clinical and subclinical antibody mediated allograft rejection as well as T-cell mediated allograft rejection during the first year between ATG-F and Thymoglobulin was similar (35% versus 19%; p = 0.30 and 11% versus 18%; 0.54 respectively). The two-year graft function was similar with a median eGFR of 56 ml/min/1.73m2 (range 21–128) (ATG-F-group) and 51 ml/min/1.73m2 (range 22–132) (Thymo-group) (p = 0.69).ConclusionWe found no significant differences between the compared study drugs for induction treatment in immunological high-risk patients regarding safety and efficacy during follow-up with good allograft function at 2 years after transplantation.

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“…Most trials have included asymptomatic infection (i.e., infection detectable by microbiologic assay) with CMV syndrome (fever and neutropenia) and tissue-invasive disease in their criteria for CMV infection. In most prospective, randomized trials comparing ATG with other induction agents, the incidence of CMV infection was not increased when induction therapy was coupled with adequate CMV prophylaxis [18,[25][26][27][28]31]. In a study without CMV prophylaxis, the rate of CMV infection was higher in the rATG group than it was in the basiliximab group (38% vs. 11.7%;…”

Section: Atg and The Risk Of Infectionmentioning

confidence: 99%

Infectious Complications of Antilymphocyte Therapies in Solid Organ Transplantation

2009

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Antilymphocyte therapies are widely used for immunosuppression in solid organ transplantation. These agents have varied mechanisms of action, with resulting differences in the intensity and duration of immunosuppression and in associated infectious complications. Induction therapy with antithymocyte globulins is associated with a greater incidence of cytomegalovirus, Epstein-Barr virus, and BK polyomavirus infections, compared with therapy with interleukin (IL)-2a receptor antagonists. However, long-term experience with the IL-2a receptor antagonists is lacking. By contrast, the treatment of graft rejection with T cell-depleting antibodies is associated with an increased risk of opportunistic infections. This is likely a reflection of the intensification of immunosuppression in the treatment of graft rejection and, often, a failure to link the use of antilymphocyte agents to prophylaxis for infection. The use of T cell-depleting agents, especially in the treatment of acute graft rejection, must be linked to monitoring and risk-adjusted prophylaxis for Pneumocystis, other fungi, Epstein-Barr virus, BK polyomavirus, and cytomegalovirus infection.

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CMV infections after two doses of daclizumab versus thymoglobulin in renal transplant patients receiving mycophenolate mofetil, steroids and delayed cyclosporine A

Abstract: Limited dosing regimen of daclizumab with MMF, steroids and delayed CsA introduction was safe and effective. The incidence of CMV infection was not significantly different, but without chemoprophylaxis, clinical manifestations and viral replication were reduced with this regimen.

Cited by 47 publications

References 33 publications

Thymoglobulin and Its Use in Renal Transplantation: A Review

Thymoglobulin and Its Use in Renal Transplantation: A Review

A Comparison of Two Types of Rabbit Antithymocyte Globulin Induction Therapy in Immunological High-Risk Kidney Recipients: A Prospective Randomized Control Study

Infectious Complications of Antilymphocyte Therapies in Solid Organ Transplantation

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