Effectiveness and safety of two different antithymocyte globulins used in induction therapy in kidney transplant recipients: A single-center experience.

BACKGROUND: Antithymocyte globulin (ATG) is widely used as an induction therapy after kidney transplantation. The present study aimed to compare the effectiveness and safety of induction therapy between two ATG formulations, Grafalon (Fresenius® ) and Thymoglobulin (Sanofi® ), in kidney transplant patients. METHODS: This study included 140 consecutive kidney transplant recipients, 71 treated with Grafalon and 69 treated with Thymoglobulin, in the period between February 2010 and January 2018. To optimize therapy costs, considering the periodically limited drug availability and the substantial drug waste in the case of Grafalon, Thymoglobulin induction was introduced into the immunosuppressive protocol. RESULTS: The ATG total dose in mg/kg of body mass [median: 5.3 (3.7-7.1) vs 8.6 (4.3-17.3); P < .001] was significantly lower in the Thymoglobulin subgroup. There were 7 (5%) graft losses and 15 (10.7%) deaths during the first 12 months, with 66.7% of deaths due to infection complications. Patients treated with Thymoglobulin were characterized by a lower absolute lymphocyte count at day 7 and during the 12 months of follow-up, compared with the Grafalon group [236 (205-267) vs 483 (372-594), respectively; P < .001]. Logistic regression analysis showed that a lymphocyte count < 200/µL at day 7 (OR = 10.5; 95%CI, 1.6-69.0; P = .01) and age >50 years (OR = 14.6; 95%CI, 1.4-155.0; P = .03), but not type of ATG, independently increased the risk of death due to infection. The 12-month acute rejection rate was higher in the Grafalon group (25.3% vs 10.1%, P = .02). CONCLUSION: Treatment with Thymoglobulin in kidney transplant recipients resulted in more pronounced lymphopenia and a lower 12-month rate of acute rejection.

The Pre-Transplant Drop in Panel-Reactive Antibodies Titer Evaluated Using Complement-Dependent Cytotoxicity (PRA-CDC) and the Risk of Early Acute Rejection in Sensitized Kidney Transplant Recipients.

Background: The panel-reactive antibodies that use the complement-dependent cytotoxicity test (PRA-CDC) are still a standard method for monitoring the degree of immunization in kidney transplant candidates on active waiting lists in some countries, including Poland. The aim of this study was to analyze the relationship between the maximum and the last pre-transplant PRA titer on the percentage of positive cross-matches and rate of early acute rejection episodes. Material and methods: The retrospective analysis included 528 patients from two transplant centers. All patients were divided into three groups, depending on their peak and last pre-transplant PRA titers. There were 437 (82.8%) patients with peak PRA <20% (non-sensitized group, non-ST) and 91 (17.2%) patients with peak PRA >20%. Among the latter group, 38 had maintained PRA level >20% at the time of transplantation (sensitized patients, ST), whereas 53 had pre-transplant PRA ≤20% (previously sensitized patients, prev-ST). Results: The percentages of positive crossmatches were 76.9% in ST and 53.7% in prev-ST groups versus 18.4 in non-ST group (both p < 0.001). The acute rejection rates were 18.9, 17.6 and 6.8%, respectively (p < 0.001 for ST or prev-ST versus non-ST). The pre-transplant PRA titer drop did not decrease the risk of early acute rejection [OR = 1.09 (95% CI: 0.31⁻3.85)] in a multiple logistic regression analysis. The occurrences of primary graft non-function and delayed graft function were similar in all study groups. Conclusions: Previously immunized kidney transplant candidates even with substantial decrease in pre-transplant PRA-CDC levels are still at high immunological risk when compared with non-immunized patients, and they should receive lymphocyte-depleting induction therapy.