Comparative Efficacy and Safety of Low-Dose Versus Standard-Dose Rabbit Antithymocyte Globulin Induction Strategy in Kidney Transplant Recipients: Insights From a Single-Center Experience in North India.

Autor:	Khullar D; Nephrology, Max Super Speciality Hospital, Saket, New Delhi, IND., Panigrahi DK; Nephrology, Max Super Speciality Hospital, Saket, New Delhi, IND., Bagai S; Nephrology, Max Super Speciality Hospital, Saket, New Delhi, IND., Abhishek; Nephrology, Max Super Speciality Hospital, Saket, New Delhi, IND., Singh K; Nephrology, Max Super Speciality Hospital, Saket, New Delhi, IND., Gandhi KR; Department of Nephrology, Amrita Hospitals, Faridabad, IND., Prasad P; Nephrology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND., Grover R; Nephrology, Max Super Speciality Hospital, Saket, New Delhi, IND., Chhabra G; Nephrology, Max Super Speciality Hospital, Saket, New Delhi, IND., Singh NP; Nephrology, Max Super Speciality Hospital, Saket, New Delhi, IND., Gupta AK; Nephrology, Max Super Speciality Hospital, Saket, New Delhi, IND.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Sep 20; Vol. 16 (9), pp. e69770. Date of Electronic Publication: 2024 Sep 20 (Print Publication: 2024).
DOI:	10.7759/cureus.69770
Abstrakt:	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. Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee, Max Super Speciality Hospital, Saket issued approval BHR/RS/MSSH/MHIL/SKT-1/MHEC/NEPHRO/24-06. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Khullar et al.)
Databáze:	MEDLINE
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