TY - JOUR
T1 - Decreased incidence of acute rejection without increased incidence of cytomegalovirus (CMV) infection in kidney transplant recipients receiving rabbit anti-thymocyte globulin without CMV prophylaxis – a cohort single-center study
AU - de Paula, Mayara Ivani
AU - Bowring, Mary Grace
AU - Shaffer, Ashton A.
AU - Garonzik-Wang, Jacqueline
AU - Bessa, Adrieli Barros
AU - Felipe, Claudia Rosso
AU - Cristelli, Marina Pontello
AU - Massie, Allan B.
AU - Medina-Pestana, Jose
AU - Segev, Dorry L.
AU - Tedesco-Silva, Helio
N1 - Funding Information:
This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001. The authors thank the Epidemiology Research Group in Organ Transplantation for supporting the development of this study. The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the U.S. Government. Funding for this study was provided in part by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) grant numbers: F30DK116658 (PI: Shaffer) and K24DK101828 (PI: Segev).
Funding Information:
This study was financed in part by the Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior ? Brasil (CAPES) ? Finance Code 001. The authors thank the Epidemiology Research Group in Organ Transplantation for supporting the development of this study. The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the U.S. Government. Funding for this study was provided in part by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) grant numbers: F30DK116658 (PI: Shaffer) and K24DK101828 (PI: Segev).
Publisher Copyright:
© 2020 Steunstichting ESOT. Published by John Wiley & Sons Ltd
PY - 2021/2
Y1 - 2021/2
N2 - Induction therapy with rabbit anti-thymocyte globulin (rATG) in low-risk kidney transplant recipients (KTR) remains controversial, given the associated increased risk of cytomegalovirus (CMV) infection. This natural experiment compared 12-month clinical outcomes in low-risk KTR without CMV prophylaxis (January/3/13–September/16/15) receiving no induction or a single 3 mg/kg dose of rATG. We used logistic regression to characterize delayed graft function (DGF), negative binomial to characterize length of hospital stay (LOS), and Cox regression to characterize acute rejection (AR), CMV infection, graft loss, death, and hospital readmissions. Recipients receiving 3 mg/kg rATG had an 81% lower risk of AR (aHR 0.140.190.25, P < 0.001) but no increased rate of hospital readmissions because of infections (0.680.911.21, P = 0.5). There was no association between 3 mg/kg rATG and CMV infection/disease (aHR 0.861.101.40, P = 0.5), even when the analysis was stratified according to recipient CMV serostatus positive (aHR 0.941.251.65, P = 0.1) and negative (aHR 0.280.571.16, P = 0.1). There was no association between 3 mg/kg rATG and mortality (aHR 0.511.253.08, P = 0.6), and graft loss (aHR 0.340.731.55, P = 0.4). Among low-risk KTR receiving no CMV pharmacological prophylaxis, 3 mg/kg rATG induction was associated with a significant reduction in the incidence of AR without an increased risk of CMV infection, regardless of recipient pretransplant CMV serostatus.
AB - Induction therapy with rabbit anti-thymocyte globulin (rATG) in low-risk kidney transplant recipients (KTR) remains controversial, given the associated increased risk of cytomegalovirus (CMV) infection. This natural experiment compared 12-month clinical outcomes in low-risk KTR without CMV prophylaxis (January/3/13–September/16/15) receiving no induction or a single 3 mg/kg dose of rATG. We used logistic regression to characterize delayed graft function (DGF), negative binomial to characterize length of hospital stay (LOS), and Cox regression to characterize acute rejection (AR), CMV infection, graft loss, death, and hospital readmissions. Recipients receiving 3 mg/kg rATG had an 81% lower risk of AR (aHR 0.140.190.25, P < 0.001) but no increased rate of hospital readmissions because of infections (0.680.911.21, P = 0.5). There was no association between 3 mg/kg rATG and CMV infection/disease (aHR 0.861.101.40, P = 0.5), even when the analysis was stratified according to recipient CMV serostatus positive (aHR 0.941.251.65, P = 0.1) and negative (aHR 0.280.571.16, P = 0.1). There was no association between 3 mg/kg rATG and mortality (aHR 0.511.253.08, P = 0.6), and graft loss (aHR 0.340.731.55, P = 0.4). Among low-risk KTR receiving no CMV pharmacological prophylaxis, 3 mg/kg rATG induction was associated with a significant reduction in the incidence of AR without an increased risk of CMV infection, regardless of recipient pretransplant CMV serostatus.
KW - CMV infection
KW - acute rejection
KW - low immunological risk
KW - thymoglobulin
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U2 - 10.1111/tri.13800
DO - 10.1111/tri.13800
M3 - Article
C2 - 33314321
AN - SCOPUS:85098334254
SN - 0934-0874
VL - 34
SP - 339
EP - 352
JO - Transplant International
JF - Transplant International
IS - 2
ER -