Safety and Feasibility of Outpatient Rabbit Antithymocyte Globulin Induction Therapy Administration in Kidney Transplant Recipients

2018 ◽  
Vol 38 (6) ◽  
pp. 620-627 ◽  
Author(s):  
Alexandra N. Varga ◽  
David Johnson ◽  
Deirdre L. Sawinski ◽  
Mary Ann Lim ◽  
Roy D. Bloom ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Induction Therapy ◽  
Antithymocyte Globulin ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Rabbit Antithymocyte Globulin

scholarly journals Incidence, Risk Factors, and Outcomes of Kidney Transplant Recipients Treated With Both Basiliximab and Antithymocyte Globulin

2020 ◽  
Vol 7 ◽  
pp. 205435812096406
Author(s):  
Rachel Jeong ◽  
Robert R. Quinn ◽  
Krista L. Lentine ◽  
Pietro Ravani ◽  
Feng Ye ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Kidney Transplant ◽  
Induction Therapy ◽  
Graft Failure ◽  
Antithymocyte Globulin ◽  
Graft Function ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Incidence Risk

Background: Kidney transplant recipients are given induction therapy to rapidly reduce the immune response and prevent rejection. Guidelines recommend that an interleukin-2 receptor antibody (basiliximab) be the first-line agent and that a lymphocyte-depleting agent (antithymocyte globulin [ATG]) be reserved for those at high immunologic risk. Objective: To determine the incidence, risk factors, and outcomes for patients who receive both basiliximab and ATG for induction compared to either agent alone. Design: Retrospective cohort study. Setting: We used the transplant electronic medical record at the University of Alberta Hospital in Edmonton, Canada. Patients/samples/participants: We included incident adult kidney transplant recipients from 2013 to 2018. Measurements: We measured baseline characteristics, type, and dose of induction therapy used, estimated glomerular filtration rate (eGFR) at 1-year posttransplant, and outcomes of all-cause graft failure, death-censored graft failure, all-cause mortality, and death with a functioning graft. Methods: Differences between induction groups were compared using chi-square test for categorical variables and Kruskal-Wallis tests for continuous variables. We performed multivariable logistic regression modeling with type of induction therapy as the dependent variable and the case-level factors as the predictors (adjusted odds ratio). We estimated the Kaplan-Meier failure functions and used log-rank tests to assess statistical significance of differences in unadjusted incidence across induction therapy types. We compared cumulative incidence functions using a Fine and Gray competing risk regression model. Results: In all, 430 kidney transplant recipients were followed for a mean of 3.9 years (standard deviation 1.5). Of these, 71% (n = 305) received basiliximab alone, 22% (n = 93) received ATG alone, and 7% (n = 32) received both basiliximab and ATG. After adjusting for age and sex, compared to the basiliximab alone group, patients were more likely to receive dual-induction therapy if they were sensitized (calculated panel reactive antibody ≥80%), had diabetes mellitus or peripheral vascular disease, or experienced delayed graft function. Compared to the ATG alone group, the dual-induction therapy group had worse graft function at 1 year (mean eGFR 42 vs. 59 mL/min/1.73 m2, P = .0008) and an increased risk of all-cause graft failure (31% vs. 13%, P = .02) and death-censored graft failure (16% vs. 4%, P = .03). Limitations: There is a risk of confounding by indication, as patients who received dual-induction therapy likely had worse outcomes due to the indication for dual-induction therapy (such as delayed graft function). Conclusions: In our study, 1 out of 10 recipients who were treated with basiliximab also received ATG for induction therapy. These patients experienced worse outcomes than those treated with ATG alone. Trial registration: Not applicable (cohort study).

COMPARISON OF BASILIXIMAB TO RABBIT ANTITHYMOCYTE GLOBULIN INDUCTION IN KIDNEY TRANSPLANT RECIPIENTS.

2000 ◽  
Vol 69 (Supplement) ◽  
pp. S159 ◽  
Author(s):  
Ibrahim Ahmad ◽  
Beverley Ketel ◽  
Gary Barone ◽  
Yousri Barri ◽  
Kristie Reed ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Antithymocyte Globulin ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Rabbit Antithymocyte Globulin

scholarly journals Serum Sickness After Treatment With Rabbit Antithymocyte Globulin in Kidney Transplant Recipients With Previous Rabbit Exposure

2010 ◽  
Vol 55 (1) ◽  
pp. 141-143 ◽  
Author(s):  
Raghavender Boothpur ◽  
Karen L. Hardinger ◽  
Rebecca M. Skelton ◽  
Brunilda Lluka ◽  
Matthew J. Koch ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Antithymocyte Globulin ◽  
Serum Sickness ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Rabbit Antithymocyte Globulin

scholarly journals Comparison of Induction Therapy Using Antithymocyte Globulin and Using Basiliximab for Live Donor Kidney Transplant Recipients: A Single Centre Prospective Cohort Study

2016 ◽  
Vol 9 (6) ◽  
pp. 187 ◽  
Author(s):  
Sanket Patel ◽  
Dr. Kalpesh Gohel ◽  
Dr. Bharat Patel
Keyword(s):  
Kidney Transplant ◽  
Graft Survival ◽  
Induction Therapy ◽  
Antithymocyte Globulin ◽  
Live Donor ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Donor Kidney ◽  
Live Donor Kidney ◽  
Live Donor Kidney Transplant

Objective: Acute rejections (AR) have a negative impact on long-term graft survival and are the major predictor of chronic rejection. Induction therapy is used to reduce AR and prevent delayed graft function (DGF). Antithymocyte globulin (ATG) and basiliximab are mainly used for this purpose. In this prospective, cohort study, we analysed and compared the safety and efficacy of ATG and basiliximab in induction therapy for live donor kidney transplant recipients.Methods: Graft survival, AR-free survival, renal function, DGF and tolerability were compared in patients who underwent live-donor transplantation between January 2014 and August 2014 at Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.Results and Discussion: A total of 85 live-donor kidney transplant recipients who enrolled were followed up for 12 mo. The incidence of AR was greater in the basiliximab group, as compared with the ATG group (25.6% versus 7.1%, p <0.05). The incidence of antibody treated AR was also greater (18.6% versus 2.4 %, p < 0.05). Patient survival rate and graft survival rate were 95.2% and 92.9% in the ATG group, respectively, compared with 90.4%and 90.7% in the basiliximab group, respectively. The incidence of adverse events was higher in the ATG group compared with the basiliximab group (71.4% versus 48.3%, p<0.05).Conclusion: The incidence of AR and antibody-treated AR was significantly higher in the basiliximab group than in the ATG cohort. However, ATG was associated with significantly higher incidence of adverse events and leucopenia than basiliximab. Both the strategies were achieved similar patient and graft survival.

Immunosuppressive Management of Pediatric Kidney Transplant Recipients

2020 ◽  
Vol 26 (28) ◽  
pp. 3451-3459
Author(s):  
Tomáš Seeman
Keyword(s):  
Immunosuppressive Therapy ◽  
Kidney Transplant ◽  
Induction Therapy ◽  
Graft Loss ◽  
Calcineurin Inhibitors ◽  
Mtor Inhibitors ◽  
Therapeutic Drug ◽  
High Dose ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

: Kidney transplantation is a preferable treatment of children with end-stage kidney disease. All kidney transplant recipients, including pediatric need immunosuppressive medications to prevent rejection episodes and graft loss. : Induction therapy is used temporarily only immediately following transplantation while maintenance immunosuppressive drugs are started and given long-term. There is currently no consensus regarding the use of induction therapy in children; its use should be decided based on the immunological risk of the child. : The recent progress shows that the recommended strategy is to use as maintenance immunosuppressive therapy a combination of a calcineurin inhibitor (preferably tacrolimus) with an antiproliferative drug (preferably mycophenolate mofetil) with steroids that can be withdrawn early or late in low-risk children. The mTOR-inhibitors (sirolimus, everolimus) are used rarely in pediatrics because of common side effects and no evidence of a benefit over calcineurin inhibitors. The use of calcineurin inhibitors, mycophenolate, and mTOR-inhibitors should be followed by therapeutic drug monitoring. : Immunosuppressive therapy of acute rejection consists of high-dose steroids and/or anti-lymphocyte antibodies (T-cell mediated rejection) or plasma exchange, intravenous immunoglobulines and/or rituximab (antibodymediated rejection). : The future strategies for research are mainly precise characterisation of children needing induction therapy, more specific indications for mTOR-inhibitors and for the far future, the possibility to reach the immuno tolerance.

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