The influence of the antithymocyte globulin dose on clinical outcomes of patients undergoing kidney retransplantation.

Optimizing antithymocyte globulin (rATG) dosage is critical for high immunological risk patients undergoing a repeat kidney transplant. This natural retrospective cohort study compared clinical outcomes of two successive cohorts of consecutive recipients of retransplants receiving 5 x 1 mg/kg (rATG-...

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Autores principales:	Kamilla Linhares, Julia Bernardi Taddeo, Marina Pontello Cristelli, Henrique Proença, Klaus Nunes Ficher, Renato de Marco, Maria Gerbase-DeLima, Jose Medina-Pestana, Helio Tedesco-Silva
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/22173c1907da4aefbef01016765c654a
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spelling	oai:doaj.org-article:22173c1907da4aefbef01016765c654a2021-12-02T20:05:38ZThe influence of the antithymocyte globulin dose on clinical outcomes of patients undergoing kidney retransplantation.1932-620310.1371/journal.pone.0251384https://doaj.org/article/22173c1907da4aefbef01016765c654a2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0251384https://doaj.org/toc/1932-6203Optimizing antithymocyte globulin (rATG) dosage is critical for high immunological risk patients undergoing a repeat kidney transplant. This natural retrospective cohort study compared clinical outcomes of two successive cohorts of consecutive recipients of retransplants receiving 5 x 1 mg/kg (rATG-5, n = 100) or a single 3 mg/kg (rATG-3, n = 110) dose of rATG induction therapy. All patients had negative complement-dependent cytotoxicity crossmatch and no anti-HLA A, B, DR donor-specific antibodies (DSA). The primary endpoint was efficacy failure (first biopsy-proven acute rejection, graft loss, or death) at 12 months. There was no difference in the cumulative incidence of efficacy failure (18.0% vs. 21.8%, HR = 1.22, 95% CI 0.66-2.25), respectively. There were no differences in 3-years freedom from biopsy proven acute rejection, and patient, graft, and death-censored graft survivals. There were no differences in the incidence of surgical complications (25.0% vs. 18.2%; p 0.151), early hospital readmission (27.8% vs. 29.5%; p = 0.877) and CMV infections (49% vs. 40%; p = 0.190). There were also no differences in the incidence (59.6% vs. 58.7%, p = 0.897) and duration of delayed graft function but a stable difference in estimate glomerular filtration rate was observed from month 1 (54.7±28.8 vs. 44.1±25.3 ml/min/1.73 m2, p = 0.005) to month 36 (51.1±27.7 vs. 42.5±24.5, p = 0.019). Mean urinary protein concentration (month 36: 0.38±0.81 vs. 0.70±2.40 g/ml, p = 0.008) and mean chronic glomerular Banff score in for cause biopsies (months 4-36: 0.0±0.0 vs. 0.04±0.26, p = 0.044) were higher in the rATG-3 group. This cohort analysis did not detect differences in the incidence of efficacy failure and in safety outcomes at 12 months among recipients of kidney retransplants without A, B, and DR DSA, receiving induction therapy with a single 3 mg/kg rATG dose or the traditional 5 mg/kg rATG.Kamilla LinharesJulia Bernardi TaddeoMarina Pontello CristelliHenrique ProençaKlaus Nunes FicherRenato de MarcoMaria Gerbase-DeLimaJose Medina-PestanaHelio Tedesco-SilvaPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 5, p e0251384 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Kamilla Linhares Julia Bernardi Taddeo Marina Pontello Cristelli Henrique Proença Klaus Nunes Ficher Renato de Marco Maria Gerbase-DeLima Jose Medina-Pestana Helio Tedesco-Silva The influence of the antithymocyte globulin dose on clinical outcomes of patients undergoing kidney retransplantation.
description	Optimizing antithymocyte globulin (rATG) dosage is critical for high immunological risk patients undergoing a repeat kidney transplant. This natural retrospective cohort study compared clinical outcomes of two successive cohorts of consecutive recipients of retransplants receiving 5 x 1 mg/kg (rATG-5, n = 100) or a single 3 mg/kg (rATG-3, n = 110) dose of rATG induction therapy. All patients had negative complement-dependent cytotoxicity crossmatch and no anti-HLA A, B, DR donor-specific antibodies (DSA). The primary endpoint was efficacy failure (first biopsy-proven acute rejection, graft loss, or death) at 12 months. There was no difference in the cumulative incidence of efficacy failure (18.0% vs. 21.8%, HR = 1.22, 95% CI 0.66-2.25), respectively. There were no differences in 3-years freedom from biopsy proven acute rejection, and patient, graft, and death-censored graft survivals. There were no differences in the incidence of surgical complications (25.0% vs. 18.2%; p 0.151), early hospital readmission (27.8% vs. 29.5%; p = 0.877) and CMV infections (49% vs. 40%; p = 0.190). There were also no differences in the incidence (59.6% vs. 58.7%, p = 0.897) and duration of delayed graft function but a stable difference in estimate glomerular filtration rate was observed from month 1 (54.7±28.8 vs. 44.1±25.3 ml/min/1.73 m2, p = 0.005) to month 36 (51.1±27.7 vs. 42.5±24.5, p = 0.019). Mean urinary protein concentration (month 36: 0.38±0.81 vs. 0.70±2.40 g/ml, p = 0.008) and mean chronic glomerular Banff score in for cause biopsies (months 4-36: 0.0±0.0 vs. 0.04±0.26, p = 0.044) were higher in the rATG-3 group. This cohort analysis did not detect differences in the incidence of efficacy failure and in safety outcomes at 12 months among recipients of kidney retransplants without A, B, and DR DSA, receiving induction therapy with a single 3 mg/kg rATG dose or the traditional 5 mg/kg rATG.
format	article
author	Kamilla Linhares Julia Bernardi Taddeo Marina Pontello Cristelli Henrique Proença Klaus Nunes Ficher Renato de Marco Maria Gerbase-DeLima Jose Medina-Pestana Helio Tedesco-Silva
author_facet	Kamilla Linhares Julia Bernardi Taddeo Marina Pontello Cristelli Henrique Proença Klaus Nunes Ficher Renato de Marco Maria Gerbase-DeLima Jose Medina-Pestana Helio Tedesco-Silva
author_sort	Kamilla Linhares
title	The influence of the antithymocyte globulin dose on clinical outcomes of patients undergoing kidney retransplantation.
title_short	The influence of the antithymocyte globulin dose on clinical outcomes of patients undergoing kidney retransplantation.
title_full	The influence of the antithymocyte globulin dose on clinical outcomes of patients undergoing kidney retransplantation.
title_fullStr	The influence of the antithymocyte globulin dose on clinical outcomes of patients undergoing kidney retransplantation.
title_full_unstemmed	The influence of the antithymocyte globulin dose on clinical outcomes of patients undergoing kidney retransplantation.
title_sort	influence of the antithymocyte globulin dose on clinical outcomes of patients undergoing kidney retransplantation.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/22173c1907da4aefbef01016765c654a
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The influence of the antithymocyte globulin dose on clinical outcomes of patients undergoing kidney retransplantation.

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