Early Outcomes of Thymoglobulin and Basiliximab Induction in Kidney Transplantation: Application of Statistical Approaches to Reduce Bias in Observational Comparisons

Willoughby, Lisa M.; Brennan, Daniel C.; Pinsky, Brett; Dzebisashvili, Nino; Buchanan, Paula; Neri, Luca; Rocca-Rey, Lisa; Abbott, Kevin C.; Lentine, Krista L.

doi:10.1097/tp.0b013e3181a484d7

Cited by 60 publications

(51 citation statements)

References 25 publications

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“…It was suggested that more potent induction therapy with thymoglobulin can decrease the incidence of acute rejection and may prolong graft survival in high risk patients. [24][25][26] Therefore, induction with a T-cell depleting antibody should be considered for HLA-6-antigen mismatched deceased-donor kidney transplants. oe This study provides the fi rst singlecenter data examining the effect of HLA match on long-term graft survival.…”

Section: Discussionmentioning

confidence: 99%

HLA‐matched kidney transplantation in the era of modern immunosuppressive therapy

Amatya

Florman

Paramesh

et al. 2010

Dialysis & Transplantation

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BACKGROUNDThe effect of HLA match on renal graft survival has become controversial as has the policy of mandatory sharing of kidneys.METHODWe performed a retrospective analysis of HLA matched (M) and mismatched (MM) kidney transplants in our center. Tacrolimus, mycophenolic acid, and steroids were used as maintenance therapy and basiliximab induction was added for high‐risk patients.RESULTA total of 229 kidney transplants were included with median follow‐up of 5.1 years. The 5‐year death‐censored graft survival by Kaplan‐Meier method was significantly higher in the M group than in the MM group for deceased‐donor kidney transplants (log‐rank, p = .018). This graft survival advantage was detected in patients with a peak panel reactive antibody (PRA) greater than 20% (p = .023), but not in those with a PRA level of less than 20% (p = .32). The graft survival was not statistically different for live donor kidney transplants (p = .077). A mismatched kidney was an independent risk for graft loss (hazard ratio: 2.27, 95% confidence interval: 1.009–5.09, p = .047) and acute rejection was a significant cause of graft loss in mismatched deceased‐donor transplants (p = .035).CONCLUSIONAcute rejection remains a significant cause of graft loss in HLA‐6‐antigen mismatched deceased‐donor kidney transplants. Our data support mandatory sharing of HLA‐matched kidneys in sensitized patients with a PRA level greater than 20%.

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Section: Discussionmentioning

confidence: 99%

HLA‐matched kidney transplantation in the era of modern immunosuppressive therapy

Amatya

Florman

Paramesh

et al. 2010

Dialysis & Transplantation

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“…2,22 With the development of ATG induction and maintenance immunosuppression with mycophenolate mofetil, tacrolimus, and steroids, rejection rates have decreased. 9,[11][12][13][14] Transplant kidney biopsy, the criterion standard for diagnosing rejection, is usually performed after the transplant in patients with DGF. The timing of these posttransplant biopsies in the setting of DGF remains controversial.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 Antithymocyte globulin use is associated with significant reduction in the incidence of acute rejection, graft loss, and patient death when used with tacrolimus, and mycophenolate mofetil, and with and without steroids. 14 Renal allograft biopsy remains the criterion standard for diagnosing rejection. In the setting of DGF, it has been recommended that biopsies be performed at 1-week intervals, starting 7 days after surgery.…”

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confidence: 99%

Early Allograft Biopsies Performed During Delayed Graft Function May Not Be Necessary Under Thymoglobulin Induction

Ortíz

Parsikia²,

Mumtaz³

et al. 2012

Exp Clin Transplant

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Objectives: Delayed graft function affects up to 50% of kidney transplant recipients. Some guidelines recommend surveillance biopsies beginning 7 days after engraftment. This may be unnecessary with anti-thymocyte globulin induction. Materials and Methods: We conducted a retrospective study of deceased-donor renal transplant recipients with delayed graft function. Results: One hundred eleven patients met the inclusion criteria. The incidence of rejections during delayed graft function was 2.7%. They were diagnosed between 9 and 11 days after transplant. The subsequent incidence of rejection at 12-month follow-up was 13.5% (n=15). The median time to rejection after transplant was 10 weeks. Fourteen of 15 patients had subtherapeutic immunosuppression. The only risk factor associated with later rejection after delayed graft function was use of donors after cardiac death. Conclusions: Early rejection during delayed graft function with anti-thymocyte globulin induction and maintenance immunosuppression with tacrolimus, mycophenolate mofetil, and steroids is rare. When later rejection occurs, it is at a median of 10 weeks after a transplant. Two of the 3 early rejections were antibody mediated. Later rejections were associated with subtherapeutic immunosuppression and donors after cardiac death. Biopsies need not be performed during the early postoperative period when anti-thymocyte globulin is used with tacrolimus, mycophenolate mofetil, and steroids.

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“…Alemtuzumab and emergence of some autoimmune diseases. This effect has been attributed to memory T-cell 56 . ATG is the agent studied extensively due to its significant beneficial impact on the recipient and graft, to standardized its dose and establish a minimum dose benefit ratio in order to avoid untoward effects which could result due to higher dosages.…”

Section: And54mentioning

confidence: 99%

The Anti-thymocyte Globulin use makes kidney transplantation journey smooth

Mahmood¹,

Ahmed²,

Aqeel³

et al. 2018

Int. j. endorsing health sci. res.

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Background: The most common immunosuppressant, Anti-thymocyte Globulin (ATGs) has been widely used by clinicians for the treatment and prevention of rejection at the time of organ transplant. Transplantation is the best option for the people with renal failure at end stage, requiring replacement of renal therapy. This is a promising treatment option with significant benefits in terms of mortality and morbidity. ATG prevents organ rejection by inhibition of activated T-cells and other immune and nonimmune cells. The aim of the study was to compare different induction regimens with ATG for the survival of smooth kidney transplantation. Methodology: Studies of the last 20 years, focusing on kidney transplantation and the efficacy of antithymocyte use for kidney transplantation were reviewed for the study literature. The keywords used were Kidney Transplantation, Induction agents, ATG, Allograft, Immunosuppressant Agents. Results: Literature suggested that the most important problem with transplantation is the protection of the allograft from activated immunological forces, which begin to react early in the period after transplantation and cause significant damage with serious short-term and long-term consequences. This process is called rejection, which is usually classified as cell-mediated and antibody-mediated rejection. The phenomenon mediated by cells causes concern, as it is the cause of future failures and damage to the allograft. To combat these phenomena with different results, various strategies were adopted. Among these therapies, ATG has recognized the exceptional importance of preventing cellular mediated rejection, allowing allotransplants to function smoothly with the greatest possible long-term benefits. Conclusion: It can be concluded on the basis of previous studies that ATG as an induction agent, is more efficient in reducing the rejection rate in the renal transplantation as compared with other agents.

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Early Outcomes of Thymoglobulin and Basiliximab Induction in Kidney Transplantation: Application of Statistical Approaches to Reduce Bias in Observational Comparisons

Abstract: Background-Retrospective comparison of treatment-related kidney transplant outcomes may be facilitated by multivariable statistical adjustments and case-matching.

Cited by 60 publications

References 25 publications

HLA‐matched kidney transplantation in the era of modern immunosuppressive therapy

HLA‐matched kidney transplantation in the era of modern immunosuppressive therapy

Early Allograft Biopsies Performed During Delayed Graft Function May Not Be Necessary Under Thymoglobulin Induction

The Anti-thymocyte Globulin use makes kidney transplantation journey smooth

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