No Indication of Increased CMV Infection in Kidney Transplant Recipients without Pharmacological Prophylaxis Receiving a Single 3mg/kg Dose of Rabbit Anti-Thymocyte Globulin (ATG) Instead of No-Induction

M. Ivani de Paula, M. Grace Bowring, A. A. Shaffer, J. Garonzik-Wang, A. Barros Bessa, C. Rosso Felipe, M. Pontello Cristelli, A. B. Massie, J. Medina Pestana, H. Silva Junior, D. L. Segev

Hospital do Rim, Nephrology Division, EPM - UNIFESP, São Paulo, Brazil

Meeting: 2019 American Transplant Congress

Abstract number: B240

Keywords: Antilymphocyte antibodies, Cytomeglovirus, Kidney, Rejection

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: Induction therapy with rabbit anti-thymocyte globulin (ATG) in patients at low immunological risk remains controversial, given increased risk of cytomegalovirus (CMV) infection

*Methods: To investigate this, we studied 932 low-risk (defined as patients (PRA<50%) with living and standard donors) kidney transplant recipients (KTR) without CMV prophylaxis at Hospital do Rim, Brazil (1/3/13-9/16/15).

*Results: We used Cox and negative binomial regression to characterize post-transplant outcomes associated with 3mg/kg of ATG or no-induction after adjusting for baseline characteristics. Patients who received ATG 3mg/kg had 80% lower risk of acute rejection (aHR _0.140.19_0.25, p<0.001). While in the crude analysis, the risk of CMV infection was higher among patients receivingrATG versus no-induction (HR _1.051.33_1.68, p<0.001), after adjustments, the risk of CMV was similar among patients in each group (aHR _0.861.10_1.40, p=0.45). The association between ATG 3mg/kg and risk of infection varied by recipient pre-transplant CMV serostatus (p-interaction=0.006). Risk of graft loss (aHR _0.340.73_1.55, p=0.41), mortality (aHR _0.511.25_3.08, p=0.62) and post-KT hospital readmissions (aHR _0.750.93_1.14, p=0.47) were similar between those who received ATG versus no-induction.

*Conclusions: Among low-risk KTR receiving azathioprine, regardless of recipient pre-transplant CMV serostatus, single 3mg/kg dose of ATG was not associated with an increased risk of CMV infection. Therefore, pharmacological prophylaxis may not be necessary for low-risk CMV KTR.

To cite this abstract in AMA style:

Paula MIvanide, Bowring MGrace, Shaffer AA, Garonzik-Wang J, Bessa ABarros, Felipe CRosso, Cristelli MPontello, Massie AB, Pestana JMedina, Junior HSilva, Segev DL. No Indication of Increased CMV Infection in Kidney Transplant Recipients without Pharmacological Prophylaxis Receiving a Single 3mg/kg Dose of Rabbit Anti-Thymocyte Globulin (ATG) Instead of No-Induction [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/no-indication-of-increased-cmv-infection-in-kidney-transplant-recipients-without-pharmacological-prophylaxis-receiving-a-single-3mg-kg-dose-of-rabbit-anti-thymocyte-globulin-atg-instead-of-no-induct/. Accessed May 8, 2025.

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