Outcomes Of Dosing Weight Selection On Rabbit Anti-thymocyte Globulin Induction Immunosuppression In High-risk, Obese Renal Transplant Recipients
1Pharmacy, University of Kentucky HealthCare, Lexington, KY, 2University of Kentucky College of Pharmacy, Lexington, KY, 3Nephrology, University of Kentucky HealthCare, Lexington, KY
Meeting: 2019 American Transplant Congress
Abstract number: B208
Keywords: High-risk, Induction therapy, Infection, Obesity
Session Information
Session Name: Poster Session B: Kidney Immunosuppression: Induction Therapy
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 are limited data regarding the optimal weight-based dosing strategy for rabbit anti-thymocyte globulin (rATG) induction in renal transplantation. At our center, rATG is dosed based on total body weight (TBW) with non-obese patients receiving a dose similar to ideal body weight. Therefore, it is possible obese patients are being over-immunosuppressed. The purpose of this study was to assess the safety, efficacy, and economic outcomes associated with weight-based rATG dosing in high-risk renal transplant recipients.
*Methods: This was a retrospective chart review of high-risk renal transplant recipients who received a deceased or living donor allograft and at least one dose of rATG as induction therapy from June 2012 through June 2017. Recipients of simultaneous multi-organ transplants were excluded. High immunologic risk was defined as having a panel reactive antibody (PRA) >20%, history of transplant, or being African American. Patients were divided into two groups based on body mass index (BMI), non-obese versus obese (BMI >30 kg/m2). The primary end point was polymerase chain reaction- or culture-positive infection at 12 months.
*Results: 115 patients were included. Baseline demographics were similar between groups, except for race, BMI, and cumulative rATG dose. There was no statistically significant difference in infection, rejection, readmission, or death between groups.
| Table 1: Baseline Demographics | |||
| Demographic | Non-Obese
(n=67) |
Obese
(n=48) |
P-value |
| Recipient age, yrs | 49.0 + 12.5 | 53.0 + 10.8 | 0.070 |
| Female, % | 47.8 | 43.8 | 0.670 |
| African American, % | 38.8 | 70.8 | 0.0007 |
| Deceased donor, % | 77.6 | 81.2 | 0.636 |
| BMI, kg/m2 | 25.3 + 3.7 | 33.9 + 3.7 | 0.001 |
| PRA, % | 38.0 + 39.6 | 34.0 + 38.9 | 0.591 |
| Cumulative rATG dose (mg/kg) | 5.4 + 0.0 | 5.1 + 0.7 | 0.005 |
| Table 2: Patient Outcomes | |||
| Non-Obese
(n=67) |
Obese
(n=48) |
P-value | |
| 12 mos, % | |||
| Infection | 73.1 | 83.3 | 0.197 |
| CMV | 8.3 | 9.0 | 1 |
| BK virus | 23.9 | 35.4 | 0.177 |
| Urinary tract infection | 49.3 | 50.0 | 0.937 |
| Delayed graft function | 9.0 | 20.8 | 0.070 |
| Graft loss | 3.0 | 2.1 | 1 |
| Rejection > 1A | 11.9 | 14.6 | 0.678 |
| Death | 3.0 | 2.1 | 1 |
| 30 days, % | |||
| Hospital readmission | 19.4 | 25.0 | 0.515 |
*Conclusions: Utilizing weight-based rATG dosing strategies did not appear to impact patient outcomes when comparing non-obese to obese patients and may provide a cost-savings benefit.
To cite this abstract in AMA style:
Cordry AC, Trobaugh K, Ramsey L, Castellanos AL, Fattah H, Rendulic T. Outcomes Of Dosing Weight Selection On Rabbit Anti-thymocyte Globulin Induction Immunosuppression In High-risk, Obese Renal Transplant Recipients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-of-dosing-weight-selection-on-rabbit-anti-thymocyte-globulin-induction-immunosuppression-in-high-risk-obese-renal-transplant-recipients/. Accessed November 21, 2024.« Back to 2019 American Transplant Congress