Date: Saturday, May 2, 2015
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
There are varied Thymoglobulin® (Thymo) induction regimens accepted among transplant programs. Our center uses five doses of Thymo at 1.25mg/kg, yielding a total goal of 6.25mg/kg. Doses are decreased by 50% for absolute lymphocyte count (ALC) < 0.2 and held for ALC = 0. The primary objective was to evaluate the effect of adjusting Thymo based on ALC on rejection and infection rates.
Methods: A retrospective chart review of 123 adult kidney transplant alone recipients from January through December 2013 was conducted. Outcomes were biopsy proven acute cellular rejection (AR) and infection.
Results: Two patients were excluded due to enrollment in an induction study. The final data set included 121 patients: 100 primary transplant and 21 re-transplants. Demographics included: 83% Caucasian, 64% male and 52% deceased donor. No graft loss occurred secondary to rejection. The overall rejection rate was 16.5%.
Patients were separated into four categories based on total Thymo dosing during the induction period: ≤ 4, 4-5.4, 5.5-7 and > 7mg/kg. These groups were chosen based on a protocol goal of 6.25mg/kg, +/- 0.75 mg/kg.
There were no rejections seen in the <4mg/kg group. In the group receiving 4-5.4 mg/kg of Thymo, ten patients (27.8%) were treated for AR. Seven of the ten rejections developed 2-4 weeks post transplant. In this group of seven rejections: nine doses were adjusted for ALC< 0.2 (6 patients). Two more rejections occurred 1-3 months post transplant with both patients having one dose adjusted for ALC.
Seven patients (12.3%) were treated for AR in the 5.5-7 mg/kg group. Over half of the rejections occurred >3 months post transplant. Two rejections occurred 2-4 weeks post transplant with one patient having two doses of Thymo adjusted for ALC.
The > 7mg/kg Thymo group had three patients (12.5%) treated for AR. No rejections occurred within the first month post transplant. The main reasons these patients received a higher dose of Thymo was due to slow graft function and sub therapeutic calcineurin inhibitor levels.
Overall fungal and viral infection rate was 12.3%. The fungal and viral infection rate did not differ in the 4-5.4mg/kg group or 5.5-7mg/kg group, see table.
|Total Thymo (mg/kg)||<4||4-5.4||5.5-7||>7|
Conclusion: Compared to our goal, Thymo dose adjustments based on ALC often led to decreased Thymo use and increased rejection rates without the benefit of minimizing infection.
To cite this abstract in AMA style:Sarumi H, Borscheid C, Sieger G, Fast B, Hogan S, Vassar K, Pruett T. Thymoglobulin Dosing Efficacy: The Role of ALC on Infection and Rejection [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/thymoglobulin-dosing-efficacy-the-role-of-alc-on-infection-and-rejection/. Accessed November 28, 2020.
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