A CD3+ count-based thymoglobulin induction regimen permits delayed introduction of calcineurin inhibitors in kidney transplantation
| Autor: | Connie J. Wang, Da Zhang, James B. Wetmore, D. Diederich, Ahmad Tuffaha |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Graft Rejection
Male medicine.medical_specialty CD3 Complex Basiliximab Recombinant Fusion Proteins medicine.medical_treatment Calcineurin Inhibitors Urology Risk Factors medicine Humans Survival rate Kidney transplantation Antilymphocyte Serum Retrospective Studies Transplantation Thymoglobulin business.industry Cumulative dose Calcineurin Antibodies Monoclonal Immunosuppression Middle Aged Prognosis medicine.disease Kidney Transplantation Recombinant Proteins Surgery Survival Rate Regimen Female Kidney Diseases business Immunosuppressive Agents Follow-Up Studies Glomerular Filtration Rate medicine.drug |
| Zdroj: | Clinical Transplantation. 26:900-909 |
| ISSN: | 0902-0063 |
| Popis: | Background Withholding calcineurin inhibitors (CNIs) can be considered when graft function is inadequate following kidney transplantation (KT). Thymoglobulin (rATG) can be used to prevent acute rejection while CNIs are being withheld. Here, we report our results of a novel CNI-sparing induction protocol, which utilizes a CD3+ cell count-based rATG treatment regimen when delayed graft function (DGF) develops in the immediate postoperative period. Methods In a cohort of 153 consecutive deceased-donor KT recipients, all received a single intraoperative dose of basiliximab; 84 subsequently developed DGF and therefore received rATG (rATG+ group), while 69 demonstrated immediate graft function and received CNIs (rATG− group). Results In the rATG+ group, mean duration of therapy was 8.5 ± 6.0 d, permitting CNI initiation to be delayed until postoperative day 10.3 ± 6.2. Cumulative dose of rATG was only 5.1 ± 4.5 mg/kg while targeting CD3+ counts of ≤30 cells/mm3. CD3+ counts were reduced to a mean of 16.7 ± 17.0 cells/mm3 during therapy. At one yr, patient and graft survival rates were 97.6% and 92.9%, respectively, while the frequency of infections and malignancies were not significantly increased compared to the rATG− group. Conclusion A unique induction regimen successfully delayed CNI initiation by using modest doses of rATG to deplete CD3+ cells, while yielding excellent long-term graft outcome without increased risk of infection or malignancy. |
| Databáze: | OpenAIRE |
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