Polyclonal anti T-lymphocyte antibody therapy monitoring in kidney transplant recipients: comparison of CD3+ T cell and total lymphocyte counts

Machado, Fabiani Palagi; Vicari, Alessandra Rosa; Spuldaro, Fábio; Filho, João Batista Saldanha de Castro; Manfro, Roberto Ceratti

doi:10.31744/einstein_journal/2018ao4278

Cited by 11 publications

(27 citation statements)

References 29 publications

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“…by the commonly adopted practice of absolute lymphocyte count monitoring as an effective marker for therapeutic response to antithymocyte globulin during induction for transplant. [9][10][11][12] Although the exact pathogenesis of COVID-19 remains to be elucidated, the innate immune system has been widely accepted as a crucial player in the initial stages of infection. Combined with prototypical type I interferons (IFN) produced by any virally infected cells, IFN-gamma is produced by activated T-lymphocytes, stimulating innate macrophage-mediated immunity as the first line of defense against viral infections.…”

Section: Discussionmentioning

confidence: 99%

“…Our center experience of withholding calcineurin inhibitors and antimetabolite during the inpatient management of COVID‐19 pneumonia did not increase the risk of allograft rejection in the 30 patients included in this cohort. Profound lymphopenia—a drastic decrease in absolute lymphocyte count on admission compared to normal baseline values—was noted in most patients and suggests minimal risk of acute rejection, evidenced by the commonly adopted practice of absolute lymphocyte count monitoring as an effective marker for therapeutic response to anti‐thymocyte globulin during induction for transplant 9‐12 …”

Section: Discussionmentioning

confidence: 99%

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COVID‐19 pneumonia in kidney transplant recipients: Focus on immunosuppression management

Chen

Farghaly

Cham

et al. 2020

Transplant Infectious Dis

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The coronavirus disease of 2019, also known as COVID-19, has been declared a global pandemic due to its rapid spread and illness severity. As of June 14, 2020, over two million cases of COVID-19 have been reported in the United States, with over 115 000 deaths and counting. New York State in particular has become the epicenter of the virus, with the highest number of reported cases in the world. 1,2 This widespread disease is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a single-stranded

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

COVID‐19 pneumonia in kidney transplant recipients: Focus on immunosuppression management

Chen

Farghaly

Cham

et al. 2020

Transplant Infectious Dis

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“…One of the important issues is that the success rate of the transplant depends entirely on receiving immunosuppressive therapies. In recent years, an induction immunosuppressive regimen has been administered extensively in many transplantation centers (8). Thymoglobulin has not been approved by the Food and Drug Administration (FDA) for kidney transplantation yet.…”

Section: Discussionmentioning

confidence: 99%

“…Monoclonal and polyclonal antibodies are administrated for induction therapy with different therapeutic protocols (7). Thymoglobulin is a lymphocyte depleting polyclonal antibody and is used as an induction therapy to reduce the acute rejection of allograft (8). There is no consensus on the appropriate dosage and duration of treatment.…”

Section: Introductionmentioning

confidence: 99%

Comparison of clinical outcome of induction immunosuppressive therapy with thymoglobulin and standard therapy in kidney transplantation; a randomized double-blind clinical trial

et al. 2019

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Introduction: Thymoglobulin is a lymphocyte-depleting polyclonal antibody, administered for induction therapy at the time of kidney transplantation to reduce the risk of acute allograft rejection. The appropriate dosage and duration of therapy is controversial. The higher dosages are associated with infection and malignancy. Objectives: In this study efficacy and safety of lower dosage (in comparison with previous studies) of thymoglobulin in kidney transplant recipients was evaluated. Patients and Methods: In this clinical trial, 106 adult kidney transplant recipients, were randomized before transplantation in two groups (case and control). The case group (53 patients) were received induction therapy with thymoglobulin (1.5 mg/kg/d for 3 days) and the control group (53 patients) were received non-induction regiment. Delayed graft function (DGF), glomerular filtration rate (GFR), acute allograft rejection and thymoglobulin complications were evaluated during the first post-transplantation year. Results: Around 106 kidney transplant recipients were enrolled (71 or 66.98% deceased donor) to the study. No significant statistical differences were found in GFR at the time of discharge from hospital (P=0.399) and at 1 year (P=0.851) and acute allograft rejection (P= 0.304) between two groups. Graft survival (73.5% in case group versus 81.1% in control group, P=0.392) at month 12th was similar among groups. Additionally, no significant differences of acute allograft rejection in recipient from deceased or living donor between two groups were detected. There was a higher incidence of DGF in the control group (26.4%) than the thymoglobulin group (5.8%) and the difference was statistically significant (P= 0.004). Thrombocytopenia (17% versus 49.1%, P<0.001) and leukopenia (11.3% versus 50.9%, P<0.001) were also significantly higher in the case group. Conclusion: While the incidence of DGF was reduced in thymoglobulin group, the short-term acute allograft rejection rate was not reduced compared to the control group. However, our results require further consideration with larger samples

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“…8 Another strategy employed T-cell count monitoring to guide recurrent rATG doses, whereby rATG was given only when counts surpass a certain threshold. 9 The lack of rATG distribution into adipose tissue may allow for leveraging the pharmacokinetic profile by using ideal body weight (IBW)-based dosing, thereby reducing cumulative exposure. This approach may be particularly sensible in the setting of increasing rates of obesity in the transplant population.…”

Section: Introduction/backgroundmentioning

confidence: 99%

Ideal Body Weight-Based Dosing of Rabbit Antithymocyte Globulin for Cost Minimization in Kidney Transplantation

et al. 2021

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Introduction: Contemporary dosing strategies for rabbit anti-thymocyte globulin (rATG) in kidney transplantation aim to reduce cumulative exposure, minimizing long-term adverse events. The use of ideal body weight-based dosing has been trialed, however concern for increased rejection post-transplant exists due to lower doses of rATG. Research Questions: The primary aim of this study was to compare rejection rates between rATG dosing protocols using actual body weight and ideal body weight and secondarily to evaluate cost savings following protocol implementation. Design: This was a retrospective study surrounding implementation of an ideal body weight-based dosing protocol for rATG. We compared 75 kidney transplant recipients in whom rATG was dosed based on actual body weight (pre-protocol group) to 64 in whom dosing was based on ideal body weight (post-protocol group), following a nine-month washout. Results: The mean cumulative rATG dose in the pre-protocol group was 6.3 mg/kg of actual body weight. When ideal body weight was used in the post-protocol group, the mean dose was 4.5 mg/kg of actual body weight. The rejection rate was 18.7% pre-protocol and 23.4% postprotocol, which did not represent a statistically significant difference (p = 0.491). The actual annual cost savings after protocol implementation exceeded $162,000, approximately $2,500 per patient. Conclusion: Results suggest ideal body weight-based dosing of rATG may reduce exposure and cost, without significantly impacting the risk of rejection in kidney transplant recipients. More studies are needed to confirm these findings.

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Polyclonal anti T-lymphocyte antibody therapy monitoring in kidney transplant recipients: comparison of CD3+ T cell and total lymphocyte counts

Cited by 11 publications

References 29 publications

COVID‐19 pneumonia in kidney transplant recipients: Focus on immunosuppression management

COVID‐19 pneumonia in kidney transplant recipients: Focus on immunosuppression management

Comparison of clinical outcome of induction immunosuppressive therapy with thymoglobulin and standard therapy in kidney transplantation; a randomized double-blind clinical trial

Ideal Body Weight-Based Dosing of Rabbit Antithymocyte Globulin for Cost Minimization in Kidney Transplantation

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