Tailored Rabbit Anti-Thymocyte Globulin Induction (rATG) Dosing for Kidney Transplantation.
1MMC, Portland, ME
2MGMC, Augusta, ME.
Meeting: 2016 American Transplant Congress
Abstract number: 522
Keywords: Induction therapy, Kidney transplantation, Outcome, Rejection
Session Information
Session Name: Concurrent Session: Kidney: Induction Therapy 2
Session Type: Concurrent Session
Date: Tuesday, June 14, 2016
Session Time: 4:30pm-6:00pm
Presentation Time: 5:30pm-5:42pm
Location: Room 312
Purpose: Although rATG is the most commonly used induction immunotherapy for kidney transplantation (KT), optimal dosing remains unknown. In order to minimize adverse effects and cost, iterative QA processes led to refinement of a risk-stratified dosing strategy.
Methods: A retrospective, single center, cohort study of adult KT 7/1/08-12/1/13 encompassing complete follow through 1/1/15 was performed. The patients were categorized into groups based on their risk profile and goal cumulative rATG exposure. Non-sensitized living donor recipients (lowest immunologic risk) received 3 mg/kg. Non-sensitized deceased donor recipients (intermediate risk) received 4.5 mg/kg. The highest risk group, defined as history of prior KT, panel reactive antibody > 20%, and/or flow cytometry cross-match positivity, received 6 mg/kg.
Results: Complete data from 224 of 247 patients performed during the study period was analyzed. The mean age was 49.6 ± 12.7 years, 67.4% were male, 96% Caucasian and 12.1% preemptive. Mean follow up was 42.3 ± 20 months.
|
|
All patients (n = 224)* |
rATG =<3 mg/kg (n = 96) |
rATG 4.5 mg/kg (n = 102) |
rATG =>6 mg/kg (n = 26) |
|
Risk Stratification |
|
Low |
Moderate |
Increased |
|
Deceased Donor, n (%) |
118 (52.7) |
4 (4.2) |
93 (91.2) |
21 (80.8) |
|
Prior Transplant, n (%) |
37 (16.5) |
1 (0.1) |
13 (12.7) |
23 (88.5) |
|
Mean Cumulative rATG Dosage (mg/kg ±SD) |
4.0 ± 1.0 |
3.0 ± 0 |
4.5 ± 0 |
6.1 ± 0.3 |
|
Mean Serum Creatinine at 1 year (mg/dL, ±SD) |
1.5 ± 0.6 |
1.5 ± 0.5 |
1.5 ± 0.5 |
1.8 ± 0.9 |
|
Number of Patients with Biopsy Proven Acute Rejection (BPAR), n (%) |
21 (9.4%) |
8 (8.3%) |
9 (8.8%) |
4 (15.4%) |
|
Death-censored Graft Survival 1-year End-of-study, n (%) |
224 (100) 212 (94.6) |
96 (100) 90 (93.8) |
102 (100) 99 (97.1) |
26 (100) 23 (88.5) |
|
Deaths at 1 year, n (%) Deaths at the End of Study, n (%) |
8 (3.6) 15 (6.7) |
2 (2.1) 4 (4.2) |
4 (3.9) 9 (8.8) |
2 (7.7) 2 (7.7) |
|
Total Cost US$ Mean Cost US$ |
$2,223,974 |
$736,032 $7,667 |
$1,089,258 $11,152 |
$398,684 $15,334 |
Conclusion: Tailored rATG dosing resulted in excellent patient and graft survival rates at 1 year and 3 years after transplant. Rejection rates were low and comparable in the low and intermediate risk groups. Dose minimization permitted substantial cost savings in the low and intermediate compared with the high risk groups.
CITATION INFORMATION: Singh N, Rossi A, Savic M, Rubocki R, Parker M, Vella J. Tailored Rabbit Anti-Thymocyte Globulin Induction (rATG) Dosing for Kidney Transplantation. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Singh N, Rossi A, Savic M, Rubocki R, Parker M, Vella J. Tailored Rabbit Anti-Thymocyte Globulin Induction (rATG) Dosing for Kidney Transplantation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/tailored-rabbit-anti-thymocyte-globulin-induction-ratg-dosing-for-kidney-transplantation/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress