Evaluation of Rabbit Antithymocyte Globulin (rATG) Dosing and Incidence of Opportunistic Viral Infections in Kidney Transplant Recipients Using Tacrolimus (TAC), Mycophenolate (MPA) and Steroid Free Maintenance Immunosuppression
The Ohio State University Wexner Medical Center, Columbus, OH
Meeting: 2019 American Transplant Congress
Abstract number: B216
Keywords: Cytomeglovirus, Induction therapy, Infection, Kidney
Session Information
Session Name: Poster Session B: Kidney Infections
Session Type: Poster Session
Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: There is limited literature evaluating rATG dosing and incidence of infection with TAC/MPA and early steroid withdrawal. This study evaluates rATG dosing and overall incidence of opportunistic viral infections with this regimen.
*Methods: Single-center, retrospective study of adult kidney transplantation patients from October 10, 2016-March 30, 2018. Patients were excluded if <18 years old, received induction therapy other than rATG, and maintenance immunosuppression other than TAC and MPA. For CMV prophylaxis, valganciclovir was used in high risk (D+/R-) patients and pre-emptive monitoring was used for intermediate (D- or +/R+) risk patients. The primary outcome compared incidence of overall opportunistic viral infections (EBV, CMV, BK) in patients receiving high (> or = 4.5 mg/kg) vs low (<4.5 mg/kg) cumulative rATG dose for induction therapy. Secondary endpoints include: incidence of CMV, biopsy proven acute rejection (BPAR), kidney function (GFR), TAC levels, and graft survival at 6 months post-transplant.
*Results: Study sample included 73 high and 47 low dose rATG patients. No differences in demographics were seen between groups [Table 1]. Opportunistic viral infections occurred more frequently in the high dose rATG group (19.1% vs 36.9% p=0.037) [Fig 1, Table 2]. CMV DNAemia incidence was numerically increased in the high rATG group (30.1% vs 17.0% p=0.105). A trend towards increased early CMV infection in the high rATG dosing group was seen (log rank p value=0.077) [Fig 2]. The majority of CMV cases occurred in intermediate risk patients (D+ or -/R+) receiving no prophylactic therapy (log rank p value=0.003) [Fig 3]. No differences in graft survival, BPAR, TAC levels, and GFR were seen between groups at 6 months.
*Conclusions: High rATG dosing increased the overall rate of opportunistic viral infections at 6 months. It may increase early CMV infection rates, but additional patient recruitment is needed to confirm this trend. This data may suggest CMV prophylaxis is warranted in the intermediate risk (D- or +/R+) patient population receiving > or = 4.5 mg/kg in combination with TAC/MPA and early steroid withdrawal.
To cite this abstract in AMA style:
Stein LVon, Leino A, Amer R, Pesavento T, Winters H. Evaluation of Rabbit Antithymocyte Globulin (rATG) Dosing and Incidence of Opportunistic Viral Infections in Kidney Transplant Recipients Using Tacrolimus (TAC), Mycophenolate (MPA) and Steroid Free Maintenance Immunosuppression [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/evaluation-of-rabbit-antithymocyte-globulin-ratg-dosing-and-incidence-of-opportunistic-viral-infections-in-kidney-transplant-recipients-using-tacrolimus-tac-mycophenolate-mpa-and-steroid-free/. Accessed May 8, 2025.« Back to 2019 American Transplant Congress