BACKGROUND: Cytomegalovirus (CMV) infection is associated with significant morbidity and mortality after solid organ transplantation and the historic incidence of our institution was 77%. Aiming to verify the rate of the CMV infection/disease, this study sough to compare single low dose versus multiple high dose of rabbit antithymocyte globulin (rATG) in de novo kidney transplant recipients under preemptive therapy and no CMV pharmacological prophylaxis.

METHODS: In this observational study, we retrospectively reviewed outcomes of 102 consecutive kidney transplants (KT) receiving a single 3mg/kg dose of rATG in the first day post transplantation (G1) and compared them with historical control of 102 consecutive KT with similar immunological risk receiving rATG 1.5 mg/kg for up to 4 alternative days (G2). All KT were performed in 2014. All patients were treated with tacrolimus, mycophenolate and prednisone. Primary end-point was cumulative incidence of first CMV infection/disease in the intention to treat population. Secondary end-points included treated acute rejection, graft loss, death, renal function and safety.

RESULTS: There was 83% of KT from expanded criteria donors and the proportion of sensitized recipients (Luminex cPRA > 50%) was 17% with no difference between two groups. Mean dose of rATG was 3.0 ± 0.29 mg/kg in G1 and 4.8 ± 1.7 mg/kg in G1 (p<0.001). There were no differences in main demographic characteristics. Patients receiving low-single dose rATG induction showed lower incidence of CMV infection/disease compared to those receiving high-dose (61.8% vs. 77.5%, p=0.015). There were no differences in the incidence of treated acute rejection (14.7 vs. 9.8%, p=0.385), biopsy proven acute rejection (8.8 vs. 4.9%, p=0.390), patient (95.1 vs. 95.1%, p=0.996) and graft (91.1 vs. 90.1%, p=0.805) survivals. There were no differences in the incidence of delayed graft function (70.6 vs. 62.7%, p=0.235). Mean estimated glomerular filtration rate was 46.7±19.4 mL/min vs. 44.9±18.5 mL/min, p=0.865) respectively.

CONCLUSION: Single low-dose rATG was associated with a significant reduction in the incidence of CMV infection/disease without compromising efficacy in de novo kidney transplant recipients with no pharmacological CMV prophylaxis.

CITATION INFORMATION: Paula M, Felipe C, Cristelli M, Orlandi P, Viana L, Basso G, Carvalho P, Montenegro C, Lima A, Pietrobom I, Tedesco-Silva H, Medina-Pestana J. Reduced CMV Infection Using Single Low-Dose of Rabbit Anti-Thymocyte Globulin in Kidney Transplanted Recipients. Am J Transplant. 2016;16 (suppl 3).

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