Thymoglobulin dose optimization for induction therapy in high risk kidney transplant recipients

Cheryle Gurk-Turner, Richa Airee, Benjamin Philosophe, Debra Kukuruga, Cinthia Drachenberg, Abdolreza Haririan

Research output: Contribution to journalArticlepeer-review

Abstract

Backgound. Thymoglobulin (rATG) has become the agent of choice for induction therapy in high immunological risk kidney transplant recipients. However, its optimal dosing in this subgroup has not been studied. Methods. To evaluate the effect of total rATG dosing on graft outcomes in such patients, we conducted a retrospective cohort study of 96 adult patients who received repeat transplants (85%) or had panel reactive antibody more than 40% (19%) and were maintained on tacrolimus, mycophenolate mofetil, and steroid. Group 1 (n=33) received less than or equal to 7.5 and group 2 (n=63) received more than 7.5 mg/kg rATG. Graft and patient survival, incidence of acute rejection (AR), and 12-month serum creatinine (SCr) were examined. Results. The groups were comparable regarding demographics, donor source, retransplantation, panel reactive antibody, and human leukocyte antigen mismatch. Group 2 had more African Americans (44.4% vs. 21.2%, P=0.03). During the 25.4+18.0 months follow-up graft survival was 82.5% and 79.4%, respectively (P=0.54). Three in group 1 and four in group 2 died (P=0.65). The incidence of biopsy proven AR during the first 12-months did not differ between the groups (9.5% vs. 8.8%, respectively, P=0.9). SCr at 12 months was 1.6+0.7 in group 1 and 1.8+1.0 in group 2 (P=0.3). There was no independent association between rATG dose and graft survival (hazard ratio: 0.85, P=0.79, 95% CI: 0.26 -2.7 for group 2 vs. 1) or 1-year SCr (regression coefficient=0.02 for ln(SCr), P=0.3; 95%CI: +0.01 to 0.6). Conclusion. Our results suggest that in high risk kidney transplant recipients total rATG doses less than or equal to 7.5 mg/kg are safe and effective in achieving a low rate of AR and graft outcomes comparable to higher doses.

Original languageEnglish (US)
Pages (from-to)1425-1430
Number of pages6
JournalTransplantation
Volume85
Issue number10
DOIs
StatePublished - May 27 2008
Externally publishedYes

Keywords

  • High risk
  • Induction
  • Kidney transplantation
  • Outcome
  • Thymoglobulin

ASJC Scopus subject areas

  • Transplantation

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