Session Name: Kidney Immunosuppression: Induction Therapy
Session Date & Time: None. Available on demand.
*Purpose: Thymoglobulin induction along with modern maintenance immunosuppression has been found to have a significant reduction in acute rejection in kidney transplantation. The recommended duration to complete thymoglobulin is within 4-7 days after kidney transplant (KT). Due to its toxicity profile and cost, some centers have moved towards an expanded duration of thymoglobulin in the outpatient setting, but the efficacy of this strategy is unknown. The purpose of this research was to evaluate outcomes in KT recipients who received standard vs. extended duration of thymoglobulin.
*Methods: All KT recipients who received thymoglobulin induction between January 1st, 2017 to December 31st 2019 were included. Patients were divided into two groups (standard therapy (ST): completion of thymoglobulin induction within 7 days of KT) and (extended therapy (ET): completion of thymoglobulin induction after 7 days after KT). The primary outcomes were the incidence of delayed graft function (DGF), biopsy confirmed acute rejection at 6 months and graft and patient survival at 12 months.
|ST group (n=47)||ET group (n=57)||p-value|
|Recipient age at transplant (years), mean ±SD||53.98 + 11.34||50.81 + 13.68||0.21|
|Male gender, n(%)||30 (64)||37 (65)||0.91|
|KDPI, median [IQR]||37.5 [17-49]||30.5 [24.3-49.5]||0.61|
|%cPRA, median [IQR]||0 [0-10]||10 [0-53]||0.14|
|Total thymoglobulin dose (mg/kg), mean ±SD||4.44±0.91||5±0.87||0.001|
|Duration of thymoglobulin (days), mean ±SD||6±1||9±2||<0.001|
|Delayed graft function, n(%)||12 (25)||23 (40)||0.11|
The majority of patients were middle-aged, male, and African American (43% in the ST group vs. 60% in the ET group; p< 0.01). The majority received maintenance immunosuppression with tacrolimus, mycophenolate with or without prednisone. The incidence of acute rejection was 15% vs 12% in the ST group vs. ET group, respectively; p=0.15. There was no graft loss at 12 months. There were two non-kidney related deaths (1 death in each group) at 12 months.
*Conclusions: This data suggests that extended use of thymoglobulin for induction therapy is common at our institution. This strategy did not appear to negatively impact short term kidney transplant outcomes such as acute rejection. KT recipients who experienced DGF were more likely to receive ET most likely to delay the start of calcineurin inhibitors. Larger studies are warranted to fully evaluate the impact of this strategy in kidney transplantation.
To cite this abstract in AMA style:Sifontis NM, Coleman A, Tang D, Lau K, Karhadkar S, DiCarlo A, Diamond A. Outcomes in Standard vs. Extended Use of Thymoglobulin as Induction Therapy in Kidney Transplant Recipients [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-in-standard-vs-extended-use-of-thymoglobulin-as-induction-therapy-in-kidney-transplant-recipients/. Accessed June 13, 2021.
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