Khullar Dinesh, Panigrahi Deepak Kumar, Bagai Sahil, Singh Kulwant, Gandhi Kunal Raj, Prasad Pallavi, Grover Rahul, Chhabra Gagandeep, Singh Narinder Pal, Gupta Anish Kumar
Nephrology, Max Super Speciality Hospital, Saket, New Delhi, IND.
Department of Nephrology, Amrita Hospitals, Faridabad, IND.
Cureus. 2024 Sep 20;16(9):e69770. doi: 10.7759/cureus.69770. eCollection 2024 Sep.
Background Rabbit antithymocyte globulin (rATG) is frequently utilized as an induction therapy in kidney transplant recipients (KTRs). Full-dose rATG induction therapy (7-10 mg/kg) has been associated with increased morbidity. However, definitive data on the appropriate rATG dosage remains scarce. In this study, we evaluated the efficacy and tolerability of varying rATG doses in KTRs. Methodology A single-center, retrospective, observational study was conducted between 2009 and 2014 in a cohort of 208 KTRs who received rATG induction therapy. Patients included in the study had received two to three consecutive doses of rATG as part of their planned induction protocol. Participants were categorized into the following two groups based on the cumulative dosage of rATG received during induction therapy: group A received 2 or 2.5 mg/kg, while group B received ≥3 mg/kg. The five-year follow-up data were analyzed. Results A cumulative rATG dose of 2 or 2.5 mg/kg and ≥3 mg/kg was given to 122 and 86 patients, respectively. The incidence of delayed graft function (DGF), acute rejection episodes, total graft loss, death, and death-censored graft loss was 6.25%, 3.84%, 7.21%, 4.32%, and 2.88%, respectively. Two malignancies and 141 infectious complications were noted. There was no significant difference between the groups regarding DGF, total graft loss, death, death-censored graft loss, infectious complications, and incidence of acute rejection episodes. Deceased donor kidney transplantation was identified as a significant predictor of acute rejection episodes (odds ratio = 9.19, 95% confidence interval = 1.567-53.907; p = 0.014). Conclusions The dosage for rATG induction therapy for KTRs should be tailored based on immunological and other factors impacting graft survival, along with a comprehensive risk assessment for potential infectious complications. A cumulative dose of 2.0 or 2.5 mg/kg could be optimal, offering effective induction therapy in KTRs with excellent graft survival rates and potentially fewer infectious complications.
背景 兔抗胸腺细胞球蛋白（rATG）常用于肾移植受者（KTRs）的诱导治疗。全剂量rATG诱导治疗（7-10mg/kg）与发病率增加有关。然而，关于合适的rATG剂量的确切数据仍然稀缺。在本研究中，我们评估了不同rATG剂量在KTRs中的疗效和耐受性。方法 2009年至2014年在一组接受rATG诱导治疗的208例KTRs中进行了一项单中心、回顾性、观察性研究。纳入研究的患者作为其计划诱导方案的一部分接受了两到三剂连续的rATG。根据诱导治疗期间接受的rATG累积剂量将参与者分为以下两组：A组接受2或2.5mg/kg，而B组接受≥3mg/kg。分析了五年随访数据。结果 分别有122例和86例患者接受了累积rATG剂量2或2.5mg/kg以及≥3mg/kg。移植肾功能延迟恢复（DGF）、急性排斥反应、移植肾完全丧失、死亡以及死亡审查的移植肾丧失的发生率分别为6.25%、3.84%、7.21%、4.32%和2.88%。记录到2例恶性肿瘤和141例感染并发症。两组在DGF、移植肾完全丧失、死亡、死亡审查的移植肾丧失、感染并发症以及急性排斥反应发生率方面无显著差异。尸体供肾移植被确定为急性排斥反应的显著预测因素（比值比=9.19，95%置信区间=1.567-53.907；p=0.014）。结论 应根据影响移植肾存活的免疫和其他因素以及对潜在感染并发症的全面风险评估来调整KTRs的rATG诱导治疗剂量。累积剂量2.0或2.5mg/kg可能是最佳的，在KTRs中提供有效的诱导治疗，具有优异的移植肾存活率且潜在感染并发症较少。
