Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Delayed graft function (DGF) is common in recipients of kidney transplants from donation after cardiac death (DCD) donors, induction therapy with monoclonal or polyclonal antibodies directed against T lymphocytes is used to reduce the incidence of DGF. But not all recipients receive induction therapy, because of lacking clear indications. The fear of DCD recipients with DGF will increase the risk of rejection, and it may be associated with poor graft survival. We compared rabbit anti-thymocyte globulin (Thymoglobulin) and anti-T lymphocyte globulin (ATG-Fresenius, ATG-F) as rescue therapies after DGF for DCD recipients without induction therapy.
*Methods: We retrospectively analyzed the clinical data from 97 DCD kidney recipients with DGF who received Thymoglobulin or ATG-F as rescue therapies after the first dialysis from January 2015 to October 2017. The patients in the Thymoglobulin group (n = 52) received Thymoglobulin (1.0 mg/kg/d) for 5-7 days and those in the ATG-F group (n = 45) were received ATG-F (100 mg/d) for 5-7 days. All patients received standard triple immunosuppressive therapy with tacrolimus, mycophenolate mofetil, and prednisolone.
*Results: Thymoglobulin patients had a lower rate of acute rejection within the first year post-transplant (9.6% vs. 28.9%; P = 0.015). There was no significant difference in the duration of DGF between the two groups,and if we subgroup the patients with the duration of DGF, Thymoglobulin significantly decreased the rate of acute rejection on DGF duration > 14 days (3/28(10.27%) vs. 10/27(37.1%), P = 0.023). Two-year patient survival, graft survival and death-censored graft survival were both comparable between the Thymoglobulin (90.4%/85.6%/95.7%) and ATG-F (91.1%/84.4%/92.5%) groups. Thymoglobulin did not increase the incidence of virus, bacterial and fungal infection.
*Conclusions: Our results suggest that DCD kidney recipients without induction therapy should accept rescue therapy for DGF. Compared with ATG-F, Thymoglobulin cannot shorten the duration of DGF, but can reduce acute rejection rate and did not increased infectious complications.
To cite this abstract in AMA style:Yang H, Shi Y, Li X, Long C, Li H, Wang Z. Rabbit Anti-Thymocyte Globulin versus Anti-T Lymphocyte Globulin Rescue Therapies in Delayed Graft Function after Kidney Transplantation from Donors after Cardiac Death [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/rabbit-anti-thymocyte-globulin-versus-anti-t-lymphocyte-globulin-rescue-therapies-in-delayed-graft-function-after-kidney-transplantation-from-donors-after-cardiac-death/. Accessed August 2, 2021.
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