The Influence of Rabbit Antithymocyte Globulin (rATG) Dose on the Incidence of CMV Infection in Kidney Transplant Recipients Receiving No Pharmacological Prophylaxis. A Propensity Score Matched Cohort Analysis
1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
2Department of Nephrology, Hospital do Rim, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
3Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, Brazil.
Meeting: 2018 American Transplant Congress
Abstract number: B140
Keywords: Cytomeglovirus, Induction therapy, Rejection, Survival
Session Information
Session Name: Poster Session B: Kidney Immunosuppression: Induction Therapy
Session Type: Poster Session
Date: Sunday, June 3, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
rATG has become the agent of choice for induction therapy in sensitized patients and those receiving expanded criteria donors (ECD) allografts. However, the optimal dose of rATG that balances efficacy and rATG side effects is not well defined.We retrospectively assessed 448 high-risk kidney transplant (KT) recipients, from January 2013 to May 2015, receiving induction therapy with rATG in combination with tacrolimus, prednisone and mycophenolate and no pharmacological cytomegalovirus (CMV) prophylaxis. We evaluated two distinct rATG regimens (single dose of 3mg/kg or multiple doses with a total of at least 4mg/kg) to determine the risk of CMV infection and acute rejection. We used propensity score (PS) matching, 1:1 ratio, to create a PS matched cohort from the original cohort to adjust for the pretransplant baseline characteristics. All-cause graft failure and mortality were also analyzed using Cox proportional hazards regressions.In matched analysis, the risk of CMV infection in patients receiving a single dose of 3mg/kg of rATG was 49% lower than patients receiving a total of at least 4mg/kg (aHR 0.51; p<0.001). Interestingly, patients receiving 3 mg/kg of rATG also had a lower risk of acute rejection (aHR 0.37; p=0.001). There was no statistically significant difference in the risk of mortality and graft loss regardless of rATG dosage.
In high-risk KT recipients receiving no CMV pharmacological prophylaxis, a single 3mg/kg rATG dose was associated with lower risk of CMV infection without compromising the efficacy for the prevention of acute rejection.
Figure1:Time to first CMV infection in high-risk recipients with no pharmacological CMV prophylaxis. 
CITATION INFORMATION: Ivani de Paula M., Bae S., Garonzik-Wang J., Felipe C., Cristelli M., Massie A., Medina-Pestana J., Segev D., Tedesco Silva J�nior H. The Influence of Rabbit Antithymocyte Globulin (rATG) Dose on the Incidence of CMV Infection in Kidney Transplant Recipients Receiving No Pharmacological Prophylaxis. A Propensity Score Matched Cohort Analysis Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Paula MIvanide, Bae S, Garonzik-Wang J, Felipe C, Cristelli M, Massie A, Medina-Pestana J, Segev D, J�nior HTedescoSilva. The Influence of Rabbit Antithymocyte Globulin (rATG) Dose on the Incidence of CMV Infection in Kidney Transplant Recipients Receiving No Pharmacological Prophylaxis. A Propensity Score Matched Cohort Analysis [abstract]. https://atcmeetingabstracts.com/abstract/the-influence-of-rabbit-antithymocyte-globulin-ratg-dose-on-the-incidence-of-cmv-infection-in-kidney-transplant-recipients-receiving-no-pharmacological-prophylaxis-a-propensity-score-matched-cohort/. Accessed May 11, 2025.« Back to 2018 American Transplant Congress