UP-03.034 Is There a Relation Between Post Kidney Transplantation Antithymocyte Globulin Therapy and Wound Healing Disturbance?

Pourmand, Gholamreza; Saraji, A.; Dehghani, Sanaz; Mehrsai, Abdolrasoul; Nikoobakht, Mohammad Reza; Sajadi, Haniye Sadat; Azar, Hiba; Razeghi, Effat; Rahbar, Maryam; Hosseini, Hamed; Rezaeidanesh, M.

doi:10.1016/j.urology.2011.07.1124

Cited by 4 publications

(5 citation statements)

References 20 publications

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“…Interestingly, at 12 months, the DE arm showed a higher incidence of lymphocele, while hematoma seemed to be more frequent in the IE arm. The risk of WHC increased by >60% in case of use of ATG induction, confirming what already stated by Pourmand et al 32 in 2012, suggesting that Ab-IL2-R (namely Basiliximab) should be an induction of choice in mTORi-based IS (also in the delayed introduction protocol). The risk also increases in obese recipients (BMI, >30 kg/m 2 ) 27 ; in fact, in our series, BMI <25 kg/ m 2 proved to have a protective role on WHC; therefore, we suggest to avoid a combination therapy of ATG and mTORi, especially in overweight recipients to decrease the "synergistic effects" on WHC.…”

Section: Discussionsupporting

confidence: 82%

A 3-month, Multicenter, Randomized, Open-label Study to Evaluate the Impact on Wound Healing of the Early (vs Delayed) Introduction of Everolimus in De Novo Kidney Transplant Recipients, With a Follow-up Evaluation at 12 Months After Transplant (NEVERWOUND Study)

et al. 2020

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Background. The risk of wound healing complications (WHCs) and the early use of mammalian target of rapamycin inhibitors after kidney transplantation (KT) have not been fully addressed. Methods. The NEVERWOUND study is a 3-month, multicenter, randomized, open-label study designed to evaluate whether a delayed (ie, 28 ± 4 d posttransplant) immunosuppression regimen based on everolimus (EVR) reduces the risk of WHC versus EVR started immediately after KT. Secondary endpoints were treatment failure (biopsy-proven acute rejection, graft loss, or death), delayed graft function, patient and graft survival rates, and renal function. Results. Overall, 394 KT recipients were randomized to receive immediate (N = 197) or delayed (N = 197) EVR after KT. At 3 months, WHC-free rates in the immediate EVR versus delayed EVR arm, considering the worst-and best-case scenario approach, were 0.68 (95% confidence interval [CI], 0.62-0.75) versus 0.62 (95% CI, 0.55-0.68) (log-rank P = 0.56) and 0.70 (95% CI, 0.64-0.77) versus 0.72 (95% CI, 0.65-0.78) (log-rank P = 0.77), respectively. The 3-and 12-month treatment failure rates, delayed graft function and renal function, and patient and graft survival were not different between the arms. Conclusions. The early introduction of EVR after KT did not increase the risk of WHC, showing good efficacy and safety profile.(Transplantation 2020;104: 374-386).

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Section: Discussionsupporting

confidence: 82%

A 3-month, Multicenter, Randomized, Open-label Study to Evaluate the Impact on Wound Healing of the Early (vs Delayed) Introduction of Everolimus in De Novo Kidney Transplant Recipients, With a Follow-up Evaluation at 12 Months After Transplant (NEVERWOUND Study)

et al. 2020

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“…In the NEV-ERWOUND study, BMI of <25 kg/m 2 was identified as a predictor of WHC-free status at 12 months [18]. Besides, consideration of obesity induction with ATG and subsequent use of mTOR-I also increase wound healing complications [18,62,63]. Another important fact is that using SRL and MMF may have a synergetic effect on wound healing complications [1,16,53,54].…”

Section: Review Of Randomized Control Trials On Mtor-imentioning

confidence: 99%

“…erefore, we suggest EVL level to be kept between 3-8 ng/mL [10, 14, 69, 131-133, 135, 138, 139]. ATG induction in patients with mTOR-I should be avoided to reduce wound healing complications [18,62,63]. Since most candidates for mTOR-I are of low immunological risk, induction with basiliximab will be a reasonable option.…”

Section: Way Forward For the Use Of Mtor-imentioning

confidence: 99%

Mammalian Target of Rapamycin Inhibitors and Wound Healing Complications in Kidney Transplantation: Old Myths and New Realities

Khalil

Al-Ghamdi

Dawood

et al. 2022

Journal of Transplantation

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Mammalian target of rapamycin inhibitors (mTOR-I) lacks nephrotoxicity, has antineoplastic effects, and reduces viral infections in kidney transplant recipients. Earlier studies reported a significant incidence of wound healing complications and lymphocele. This resulted in the uncomfortable willingness of transplant clinicians to use these agents in the immediate posttransplant period. As evidence and experience evolved over time, much useful information became available about the optimal use of these agents. Understandably, mTOR-I effects wound healing through their antiproliferative properties. However, there are a lot of other immunological and nonimmunological factors which can also contribute to wound healing complications. These risk factors include obesity, uremia, increasing age, diabetes, smoking, alcoholism, and protein-energy malnutrition. Except for age, the rest of all these risk factors are modifiable. At the same time, mycophenolic acid derivatives, steroids, and antithymocyte globulin (ATG) have also been implicated in wound healing complications. A lot has been learnt about the optimal dose of mTOR-I and their trough levels, its combinations with other immunosuppressive medications, and patients’ profile, enabling clinicians to use these agents appropriately for maximum benefits. Recent randomized control trials have further increased the confidence of clinicians to use these agents in immediate posttransplant periods.

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“…The use of r-ATG has been associated with an increase incidence of WHAE. 16,17 The effect of thymoglobulin reduces peripheral T cells, which significantly influence impair breaking strength of wounds and reduce collagen disposition. 11 In our study, we were unable to associate the use of r-ATG with increased incidence of WHAE, perhaps because a single 3 mg/kg dose was used.…”

Section: Figurementioning

confidence: 99%

Wound Healing Complications in Kidney Transplant Recipients Receiving Everolimus

et al. 2017

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UP-03.034 Is There a Relation Between Post Kidney Transplantation Antithymocyte Globulin Therapy and Wound Healing Disturbance?

Cited by 4 publications

References 20 publications

A 3-month, Multicenter, Randomized, Open-label Study to Evaluate the Impact on Wound Healing of the Early (vs Delayed) Introduction of Everolimus in De Novo Kidney Transplant Recipients, With a Follow-up Evaluation at 12 Months After Transplant (NEVERWOUND Study)

A 3-month, Multicenter, Randomized, Open-label Study to Evaluate the Impact on Wound Healing of the Early (vs Delayed) Introduction of Everolimus in De Novo Kidney Transplant Recipients, With a Follow-up Evaluation at 12 Months After Transplant (NEVERWOUND Study)

Mammalian Target of Rapamycin Inhibitors and Wound Healing Complications in Kidney Transplantation: Old Myths and New Realities

Wound Healing Complications in Kidney Transplant Recipients Receiving Everolimus

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