Induction therapy with rabbit antithymocyte globulin versus basiliximab after kidney transplantation: a health economic analysis from a German perspective

Cremaschi, Liana; Versen, Regina von; Benzing, Thomas; Wiesener, Michael S.; Zink, Nikolai; Milkovich, Gary; Paivanas, Thomas A.; Gallagher, Meghan; Thaiss, Friedrich

doi:10.1111/tri.12991

Cited by 10 publications

(3 citation statements)

References 24 publications

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“…In KT recipients, recently published economic evaluations of NDI and DI have been favorable, with ATG often being preferred . However, cost‐effectiveness studies of induction in LT remain extremely limited .…”

Section: Discussionmentioning

confidence: 99%

The use of induction therapy in liver transplantation is highly variable and is associated with posttransplant outcomes

Bittermann

Hubbard

Goldberg

2019

American Journal of Transplantation

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The use of induction immunosuppression in liver transplantation (LT) remains controversial. This was a retrospective cohort study of adult, first‐time liver‐alone recipients (N = 69 349) at 114 US centers between 2005 and 2018 using data from the United Network for Organ Sharing. The comparative effectiveness of nondepleting and depleting induction (NDI and DI) was assessed. Overall, 27% of recipients received induction with 65.7% of the variance in the receipt of induction being attributed to transplant center alone. NDI and DI were associated with a lower risk of death/graft failure compared to no induction (adjusted hazard ratio 0.90 [95% confidence interval (CI): 0.86‐0.95] and 0.91 [95% CI: 0.85‐0.97], respectively; P < .001). In nondialysis recipients at the mean transplant estimated glomerular filtration rate (eGFR), NDI was associated with an adjusted gain in eGFR by 6 months of +3.8 mL/min per 1.73 m2 and DI of +3.33 mL/min per 1.73 m2 compared to no induction (P < .001). Recipients with lower eGFR at LT had greater predicted improvement in eGFR (interaction P < .001). Only NDI was associated with a reduced risk of acute rejection in the first year post‐LT (odds ratio 0.87, 95% CI: 0.8‐0.94). Significant variability in induction practices exists, with center being a major determinant. The absolute incremental benefits of NDI and DI over no induction were small.

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Section: Discussionmentioning

confidence: 99%

The use of induction therapy in liver transplantation is highly variable and is associated with posttransplant outcomes

Bittermann

Hubbard

Goldberg

2019

American Journal of Transplantation

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“…Marfo et al [ 28 ] compared the clinical and economic impact of using short-course versus standard-course ATG, with no significant differences in acute rejection episodes and a significant cost reduction using the short course. Recently, Cremashi et al [ 32 ] compared quality-adjusted life years (QALYs) between ATG and basiliximab, with a modest increase in QALYs and lower long-term costs in the ATG cohort. However, no data on liver transplantation were reported.…”

Section: Discussionmentioning

confidence: 99%

Low Total Dose of Anti-Human T-Lymphocyte Globulin (ATG) Guarantees a Good Glomerular Filtration Rate after Liver Transplant in Recipients with Pretransplant Renal Dysfunction

Dopazo

Charco

Caralt

et al. 2018

Canadian Journal of Gastroenterology and Hepatology

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We aimed to evaluate the safety and efficacy of low doses of anti-T-lymphocyte globulin (ATG)-based immunosuppression in preserving renal function and preventing liver rejection in liver transplant (LT) recipients with pretransplant renal dysfunction. We designed a prospective single-center cohort study analyzing patients with pre-LT renal dysfunction defined as eGFR<60 mL/min/1.73m2, who underwent induction therapy with ATG (ATG group, n=20). This group was compared with a similar retrospective cohort treated with basiliximab (BAS group, n=20). An economic analysis between both induction therapies was also undertaken. In the ATG group, 45% and 50% of patients had recovered their renal function without acute cellular rejection (ACR) episodes at day 7 and 1 month after LT, respectively, versus 40% and 55% of patients in the BAS group (p=1). Renal function improved in both groups over time and no differences between groups were observed regarding one-year eGRF and one-year probability of ACR. Cost per patient of the ATG course was 403€ (r: 126-756) versus 2,524€ of the basiliximab course (p=0.001). In conclusion, induction with low dose of ATG or basiliximab in patients with pretransplant renal dysfunction is a good strategy for preserving posttransplant renal function; however the use of low-dose ATG resulted in a substantial reduction in drug costs. This trail is registered with ClinicalTrials.gov number: NCT01453218.

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“…Recent reviews and registry analyses have concluded that with contemporary dosing regimens (total dose ≤6 mg/kg) rATG induction is not associated with an enhanced risk for PTLD or cancer [ 82 – 84 ]. In terms of expenditure, a recent analysis concluded that rATG or basiliximab induction incurs similar treatment costs over the first two years after kidney transplantation based on data from the high-risk population included in the randomized trial by Brennan et al [ 85 ]. Analyses have not been reported in lower-risk cohorts.…”

Section: Discussionmentioning

confidence: 99%

Does Rabbit Antithymocyte Globulin (Thymoglobuline®) Have a Role in Avoiding Delayed Graft Function in the Modern Era of Kidney Transplantation?

Guirado

2018

Journal of Transplantation

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Delayed graft function (DGF) increases the risk of graft loss by up to 40%, and recent developments in kidney donation have increased the risk of its occurrence. Lowering the risk of DGF, however, is challenging due to a complicated etiology in which ischemia-reperfusion injury (IRI) leads to acute tubular necrosis. Among various strategies explored, the choice of induction therapy is one consideration. Rabbit antithymocyte globulin (rATG [Thymoglobuline]) has complex immunomodulatory effects that are relevant to DGF. In addition to a rapid and profound T-cell depletion, rATG inhibits leukocyte migration and adhesion. Experimental studies of rATG have demonstrated attenuated IRI-related tissue damage in reperfused tissues, consistent with histological evidence from transplant recipients. Starting rATG intraoperatively instead of postoperatively can improve kidney graft function and reduce the incidence of DGF. rATG is effective in preventing acute rejection in kidney transplant recipients at high immunological risk, supporting delayed calcineurin inhibitor (CNI) introduction which protects the graft from early insults. A reduced rate of DGF has been reported with rATG (started intraoperatively) and delayed CNI therapy compared to IL-2RA induction with immediate CNI in patients at high immunological risk, but not in lower-risk patients. Overall, induction with rATG induction is the preferred choice for supporting delayed introduction of CNI therapy to avoid DGF in high-risk patients but shows no benefit versus IL-2RA in lower-risk individuals. Evidence is growing that intraoperative rATG ameliorates IRI, and it seems reasonable to routinely start rATG before reperfusion.

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Induction therapy with rabbit antithymocyte globulin versus basiliximab after kidney transplantation: a health economic analysis from a German perspective

Cited by 10 publications

References 24 publications

The use of induction therapy in liver transplantation is highly variable and is associated with posttransplant outcomes

The use of induction therapy in liver transplantation is highly variable and is associated with posttransplant outcomes

Low Total Dose of Anti-Human T-Lymphocyte Globulin (ATG) Guarantees a Good Glomerular Filtration Rate after Liver Transplant in Recipients with Pretransplant Renal Dysfunction

Does Rabbit Antithymocyte Globulin (Thymoglobuline®) Have a Role in Avoiding Delayed Graft Function in the Modern Era of Kidney Transplantation?

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