Elderly and non-sensitized renal transplant patients may benefit from lesser induction immunosuppression. This study evaluates three year clinical outcomes of a low risk renal transplant population who received novel low rabbit antithymocyte globulin (ATG) dosing.

This is a retrospective single center study of adult solitary kidney transplants from 2011 to 2014 comparing the low risk (LR) group to historic low risk controls (HC). Low risk was defined based on low PRA and/or age>65. LR received total dosing of mycophenolate mofetil (MMF) of 1.5 g/day and ATG ranging from 1.5-3 mg/kg to target absolute lymphocyte counts less than 100 cells/[micro]L. HC received 2 g/day MNF and 4.5-6 mg/kg ATG for immediate/delayed graft function. Tacrolimus goal trough levels were identical in both groups. Three year patient and graft survival, 6 month and 3 year renal function, infection, and rejection rates were reported. Univariate and Kaplan-Meier analysis were performed and p<0.05 was consider significant.

77 patients underwent renal transplant, 42 in LR and 35 in HC. Baseline demographics differed significantly including: age (LR: 59±10 vs HC: 52± 13, p=0.02), African American (21 vs 2%, p=0.046), risk stratification level (low risk: 55 vs 83%, elderly: 38 vs 6%, p=0.02). No differences in BMI (LR: 30 ± 5 vs HS: 29 ± 6, p=NS) nor % male (62 vs 60%, p=NS) were observed. There were no differences in delayed graft function rates (17 vs 17%, p=NS). ATG induction dosing per kg (2.8±0.5 vs 4.7 ± 1.6 mg/kg, p<0.01) and total ATG dose was lower in LR (225.6 ± 54 vs 441 ± 117 mg, p<0.01) with 4 LR patients receiving only one dose of 1.5 mg/kg. There were no differences in 3 year patient (95 vs 91%, p=NS) and graft survival (91 vs 89%, p=NS). No differences were observed in mean eGFR at 6 months (53 vs 60, p=NS). No differences in ACR were observed at 6 (21 vs 11, p=NS), 12 (21 vs 17, p=NS) or 36 (21 vs 20%, p=NS) months. No differences in AMR were observed at 6 (10 vs 6%, p=NS), 12 (12 vs 6, p=NS) or 36 (12 vs 6%, p=NS) months. CMV viremia rates were similar up to 12 months (24 vs 17%, p=NS). BK viremia rates were similar at 6 (5 vs 17%, p=NS) and 12 months (12 vs 20%, p=NS). ATG use was reduced by 49% in LR compared to HC representing a mean cost savings of $7822 per patient.

Low immunologic risk patients can safely receive lower doses of ATG induction while preserving excellent clinical outcomes and improving the value of care.

CITATION INFORMATION: Dann J., Ally W., Bradley M., Geyston J., Agarwal A. Novel Low Dosing of Rabbit Antithymocyte Globulin Preserves Excellent Outcomes and Improves the Value of Care in Low Risk Renal Transplantation Am J Transplant. 2017;17 (suppl 3).

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