MO980OUTCOMES OF RABBIT ANTI-THYMOCYTE GLOBULIN VERSUS IL-2 RECEPTOR ANTAGONIST INDUCTION THERAPIES IN 2DR MISMATCH RENAL TRANSPLANT RECIPIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Hatem Kaies Ibrahim Elsayed Ali ◽  
Mahmoud Mohamed ◽  
Nithya Krishnan ◽  
Shafi Malik
Keyword(s):  
Renal Transplant ◽  
Acute Rejection ◽  
Graft Survival ◽  
Induction Therapy ◽  
Regression Models ◽  
Renal Transplant Recipients ◽  
Antigen Level ◽  
Transplant Recipients ◽  
Maintenance Immunosuppression ◽  
Significant Difference

Abstract Background and Aims 2DR HLA mismatch indicates high immunological risk renal transplant. Induction therapy with rabbit Anti-thymocyte Globulin (r-ATG) and IL-2 Receptor Antagonist (IL-2RA) resulted in marked reduction of acute allograft rejection rate and improved graft survival. However, the outcomes in 2DR (HLA-DR) mismatched renal transplant recipients (RTRs) in the era tacrolimus-mycophenolate mofetil maintenance immunosuppression remains understudied. Method This was a retrospective cohort study using data from the United States Organ Procurement and Transplantation Network, all 2 DR mismatched RTRs who were maintained on tacrolimus and mycophenolate mofetil immunotherapy between 2005 and 2015 were included. Follow up data was until September 2020. Patients who received transplants from living donors were included in the study. Collected data included recipient factors (age, sex, ethnicity, diabetes, body mass index), transplant factors (delayed graft function, cold ischemia time, number of previous transplants, panel reactive antibodies, HLA-mismatches, induction therapies, maintenance immunotherapy, and donor factors (donor type, donor age). RTRs were divided into 2 groups: based on induction therapy r-ATG and IL-2RA. Instrumental variable regression models were used to assess effect of induction therapy on acute rejection episodes at 6 months post-transplant and on graft survival. Type of induction therapy was instrumented for the transplant centre to reduce the centre effect on the choice of the induction therapy. Cox proportional hazard regression analysis was performed to assess the effect of induction therapy on graft survival. The regression models were adjusted for collected recipient, donor and transplant factors. Results 3052 patients received IL2-RA while 5143 patients received R-ATG induction. Using instrumental variables regression models, there were no significant differences between IL2-RA versus R-ATG induction in acute rejection episodes (OR=1.49, 95% CI ranges from 0.73 to 3.05, P=0.27), or graft survival (coefficient=0.95, 95% CI: -0.18 to 2.10, P=0.10). Using Cox proportional hazards regression, there was no significant difference in graft survival between either induction therapies (HR=0.90, 95% CI: 0.74 to 1.09, P=0.29). Conclusion This study showed no significant difference in acute rejection episodes or graft survival when using ATG or IL-2RA in 2DR HLA mismatched renal transplant recipients in the current tacrolimus-based maintenance immunosuppression era. Therefore, IL2-RA is a safe induction therapy in this group of patients and non-inferior to R–ATG induction therapy. Moreover, this study also highlights the fact that antigen level 2DR mismatches are not a risk factor for rejection and HLA matching should be based on epitope level rather than antigen level.

scholarly journals MO012IS IT SAFE TO USE INTERLEUKIN-2 RECEPTOR ANTAGONIST INDUCTION THERAPY IN 2DR MISMATCH RENAL TRANSPLANTS IN TACROLIMUS ERA?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Hatem Kaies Ibrahim Elsayed Ali ◽  
Ahmed Daoud ◽  
Mahmoud Mohamed ◽  
Karim Soliman
Keyword(s):  
Regression Analysis ◽  
Mycophenolate Mofetil ◽  
Renal Transplant ◽  
Acute Rejection ◽  
Receptor Antagonist ◽  
Graft Survival ◽  
Induction Therapy ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Maintenance Immunosuppression

Abstract Background and Aims 2DR HLA mismatch indicates high immunological risk renal transplant. Induction therapy with rabbit Anti-thymocyte Globulin (r-ATG) and IL-2 Receptor Antagonist (IL-2RA) resulted in marked reduction of acute allograft rejection rate and improved graft survival. However, the outcomes in 2DR (HLA-DR) mismatched renal transplant recipients (RTRs) in the era tacrolimus-mycophenolate mofetil maintenance immunosuppression remains understudied. Method Using data from the United States organ procurement and transplantation network, all 2 DR mismatched RTRs with panel reactive antibodies <20% maintained on tacrolimus and mycophenolate mofetil immunotherapy between 2000 and 2017 were retrospectively reviewed. Data including age, sex, gender, ethnicity, functional status, diabetes, body mass index, cold ischemia time, number of previous transplants, panel reactive antibodies, donor type, donor age, HLA-mismatches, number of acute rejection episodes, induction therapies, maintenance immunotherapy, recipients and graft survival were collected. Based on induction therapies administered, RTRs were divided into 2 groups: (r-ATG) and IL-2RA groups. Poisson regression analysis was used to assess effect of induction therapies on acute rejection episodes. Cox hazard regression analysis was used to assess effect of different induction therapies on patient and graft survival Results 3379 patients received IL2-RA while 3677 patients received ATG for induction. There were no significant differences between both groups in terms of acute rejection episodes (95% CI ranges from 0.95 to 1.068, P=0.805), graft survival (95% CI: 0.91 - 1.06, P=0.712), or patient survival (95% CI: -0.949 - 1.12, P=0.43) . Conclusion This study revealed no significant difference in acute rejection episodes, patient or graft survival when utilizing ATG vs IL-2RA in 2DR HLA mismatched renal transplant recipients with PRA<20%, in the tacrolimus-based maintenance immunosuppression era. Therefore, IL2-RA is a safe induction therapy in this group of patients and non-inferior to –ATG induction therapy.

SP873EFFECTS OF LATE ACUTE REJECTION ON GRAFT SURVIVAL AND OUTCOME IN PEDIATRIC RENAL TRANSPLANT RECIPIENTS

2015 ◽  
Vol 30 (suppl_3) ◽  
pp. iii665-iii665 ◽  
Author(s):  
Esra Baskin ◽  
Asli Kantar ◽  
Kaan Gulleroglu ◽  
Esra Ozmen ◽  
Handan Ozdemir ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Acute Rejection ◽  
Graft Survival ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Pediatric Renal Transplant ◽  
Pediatric Renal Transplant Recipients

scholarly journals Steroid-free immunosuppression in cyclosporine-treated renal transplant recipients: a meta-analysis.

1993 ◽  
Vol 4 (6) ◽  
pp. 1300-1305
Author(s):  
D E Hricik ◽  
M A O'Toole ◽  
J A Schulak ◽  
J Herson
Keyword(s):  
Renal Transplant ◽  
Graft Survival ◽  
Steroid Therapy ◽  
Allograft Rejection ◽  
Meta Analysis ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Acute Allograft Rejection ◽  
Maintenance Immunosuppression ◽  
Prospective Trials

Data from seven randomized, prospective trials were pooled to determine the effect of steroid-free immunosuppression on allograft survival, patient survival, and the incidence of acute allograft rejection in renal transplant recipients receiving cyclosporine-based maintenance immunosuppression. Six of the seven trials incorporated into this analysis examined the effects of either complete avoidance of steroids or withdrawal of steroids less than 3 months after transplantation. Only one of the studies estimated patient and graft survival beyond 2 yr. Results of the meta-analysis suggest that avoiding steroid therapy from the time of transplantation or withdrawing steroid therapy at some time after transplantation increases the risk of acute allograft rejection without adversely affecting patient or graft survival. However, these results may not accurately reflect the risk of acute allograft rejection in patients subjected to later withdrawal of steroids. Longer periods of follow-up are required to assess the risk of chronic rejection in cyclosporine-treated renal transplant recipients who are not receiving steroids.

scholarly journals Single dose thymoglobulin induction therapy in prevention of acute rejection in renal transplant recipients

2017 ◽  
Vol 7 (1) ◽  
pp. 32-35
Author(s):  
Georgi Abraham ◽  
Madhusudan Vijayan ◽  
Rajeevalochana Parthasarathy ◽  
Milly Mathew ◽  
Saravanan Sundararaj ◽  
...  
Keyword(s):  
Single Dose ◽  
Renal Transplant ◽  
Acute Rejection ◽  
Induction Therapy ◽  
Renal Transplant Recipients ◽  
Transplant Recipients

scholarly journals P1767ERALY VERSUS LATE GRAFT PYELONEPHRITIS- A RETROSPECTIVE ANALYSIS OF GRAFT AND PATIENT OUTCOME

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Anupma Kaul ◽  
Thomas Mathews ◽  
Dharmendra Bhaduria ◽  
Narayan Prasad ◽  
Amit Gupta
Keyword(s):  
Renal Transplant ◽  
Graft Survival ◽  
Patient Survival ◽  
Univariate Analysis ◽  
Graft Loss ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Significant Difference ◽  
Dj Stent ◽  
Baseline Characteristics

Abstract Background and Aims Acute graft pyelonephritis(AGPN) is thought to affect the graft and patient survival among the renal transplant recipients.Our objective was to compare these outcomes in those having early AGPN(<6 months from transplant) versus those having late AGPN(>6months from transpant) Method This retrospective study analysed 150 patients who had AGPN over a period of 8 years from 2005 to 2013.They were divided into early AGPN group and late AGPN group .Their baseline characteristics were compared.Predictors of graftloss and mortality were compared using logistic regression analysis.Graft survival and patient survival wereanalysed using Kaplan-Meyer survival plots Results A total of 150 patients with AGPN were analysed.Of these 55.3%(n=83) had early AGPN and 44.7%(n=67) had late AGPN.These two groups were comparable regarding baseline characteristics and immunosuppression.13.3%(n=11) patients in early AGPN group had CMV disease during follow up compared to 3%(n=2) in late AGPN group(p<0.05).26.5%(n=22) in the early AGPN group had prolonged foley’s catheterization(>5days) following transplant surgery compared to 7.5%(n=5) in late AGPN group(p<0.05).38.6%(n=32) in the early AGPN group had prolonged DJ stent in-situ(>2weeks) following transplant surgery compared to 19.4%(n=13) in the late AGPN group(p<0.05).Recurrent GPN was more common in the late AGPN group than the early AGPN group-35.8%(n=24) verus 18.1%(n=15).Predictors for graft loss was assessed in patients with AGPN and presence of renal abscess was predictive of graft loss in univariate analysis(HR-6.129 ,95 % CI 1.776-21.154,p-0.004).There were no significant predictors of mortality in univariateanalysis.KaplanMeiyer survival analysis showed decreased death censored graft survival in the early AGPN group(p-0.035).There was no significant difference in the patient survival among two groups. Conclusion Occurrence of early AGPN has significant impact on long term graft survival in renal transplant recipients with no significant effect on patient survival.This study underlines the paramount importance of prevention of UTIs in renal transplant recipients.

scholarly journals Open Randomized Trial Comparing Early Withdrawal of either Cyclosporine or Mycophenolate Mofetil in Stable Renal Transplant Recipients Initially Treated with a Triple Drug Regimen

2002 ◽  
Vol 13 (2) ◽  
pp. 536-543 ◽  
Author(s):  
Peter Schnuelle ◽  
Jaap Homan van der Heide ◽  
Adam Tegzess ◽  
Cornelis A. Verburgh ◽  
Leendert C. Paul ◽  
...  
Keyword(s):  
Renal Function ◽  
Mycophenolate Mofetil ◽  
Drug Therapy ◽  
Renal Transplant ◽  
Acute Rejection ◽  
Lipid Profile ◽  
Graft Survival ◽  
Drug Regimen ◽  
Renal Transplant Recipients ◽  
Transplant Recipients

ABSTRACT. Cyclosporine (CsA) is the current primary immunosuppressant for the prevention of renal allograft rejection. Its chronic use is associated with various adverse effects like hypertension, hyperlipidemia, and nephrotoxicity, which in turn may contribute to chronic allograft nephropathy and cardiovascular mortality. This study compares a CsA-free maintenance regimen of mycophenolate mofetil (MMF) and corticosteroids with CsA and corticosteroids after early conversion from triple drug therapy. Eighty-four renal transplant recipients who had stable graft function on triple drug therapy with MMF, CsA, and steroids were randomly assigned to be withdrawn from either CsA (n = 44) or MMF (n = 40) at 3 mo posttransplantation. Kidney function at 1 yr was the primary endpoint. Secondary parameters of efficacy were patient and graft survival, incidence of acute rejection episodes, BP, and lipids. At study entry, the alternative treatment groups were similar with respect to demographics, renal function, dosage of CsA, BP, and concomitant medication. Both the creatinine clearance (71.7 versus 60.9 ml/min) and calculated GFR (73.2 versus 61.9 ml/min) were significantly better in MMF-treated patients at 1 yr. Conversion to MMF was associated with a decline of systolic and diastolic BP (128/76 versus 139/82 mmHg) and with a more favorable lipid profile. There was no difference in patient survival (100%) and graft survival (97.7% versus 100%). Acute rejection episodes occurred more frequently after withdrawal of CsA (11.3% versus 5.0%), but the difference was NS. Early tapering of CsA can safely be accomplished in renal transplant recipients who are stable on a triple drug regimen with MMF, thereby resulting in improved renal function, a more favorable lipid profile, and beneficial effects on posttransplant hypertension.

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