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Thymoglobulin Induction in Kidney Transplant Recipients: A Single Center Experience Comparing 3 Mg/kg vs 5 Mg/kg Cumulative Dosing

K. Progar1, S. January1, N. Nesselhauf1, J. Hagopian1, A. Malone2

1Transplant, Barnes-Jewish Hospital, St. Louis, MO, 2Transplant Nephrology, Washington University, St. Louis, MO

Meeting: 2020 American Transplant Congress

Abstract number: B-010

Keywords: Induction therapy, Kidney transplantation

Session Information

Session Name: Poster Session B: Kidney Immunosuppression: Induction Therapy

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: Beginning in 2016, our center implemented a protocol change to thymoglobulin (r-ATG) induction dosing in kidney transplant recipients at low rejection risk from 5 mg/kg to 3 mg/kg cumulative dose. The co-primary outcome of the study was to examine differences in rejection rates at 1 and 2 years post-transplant between the two dosing groups. Secondary outcomes included GFR, graft loss, and death rates at 1 and 2 years. Differences in the development of CMV or BKV viremia, and cancer were also examined.

*Methods: This study was a retrospective analysis of patients undergoing kidney transplantation between 1/3/15 and 6/20/17 at a single center. Low risk patients eligible for 3 mg/kg r-ATG dosing included individuals age >40 years, first transplant, PRA <20%, non-African American race, <2 DR mismatches, and negative crossmatch at the time of transplant. Rejection was defined as AMR or ACR Banff 1b and above. Chi-square test or independent samples t-test were utilized where appropriate to evaluate differences.

*Results: Sixty kidney transplant recipients received 3 mg/kg r-ATG compared to 5 mg/kg (n=279). As expected, the patients who received 3 mg/kg were significantly younger with fewer past transplants and DR mismatches as seen in Table 1. The primary outcome of rejection after transplant at 1 year was 1.7% in the 3 mg/kg group vs 3.9% in the 5 mg/kg group (p=0.39). There was no difference between groups in graft loss, patient death, or GFR at 1 and 2 years post-transplant seen in Table 2. Similar rates of CMV viremia, BK viremia, and cancer were seen in both groups at 2-year follow-up.

Table 1

3 mg/kg (n=60) 5 mg/kg (n=279) p-value
Male (n, %) 32 (53.3) 175 (62.7) 0.18
Age (median, IQR) 58.9 (50.2, 66.1) 51.3 (37.9, 61.7) <0.01
African American (n, %) 10 (16.7) 101 (36.2) <0.01
CMV high risk (n, %) 12 (20.0) 54 (19.4) 0.86
Deceased donor (n, %) 34 (56.7) 206 (73.8) 0.01
KDPI (median, IQR) 44 (27, 67) 37 (19, 57) 0.05
Prior transplant (n, %) 2 (3.3) 45 (16.1) 0.01
PRA > 20% (n, %) 12 (20.0) 79 (28.3) 0.19
2 HLA DR mismatches (n, %) 9 (15.0) 78 (30.0) 0.04
Positive crossmatch (n, %) 4 (6.7) 26 (9.3) 0.51

Table 2

3 mg/kg (n=60) 5 mg/kg (n=279) p-value
1-year rejection (n, %) 1 (1.7) 11 (3.9) 0.39
2-year rejection (n, %) 2 (3.3) 17 (6.1) 0.40
GFR 1-year (median, IQR) 56.6 (46.0, 68.5) 58.6 (47.9, 69.2) 0.53
GFR 2-year (median, IQR) 58.4 (46.2, 74.8) 59.4 (50.2, 73.2) 0.64
1-year death (n, %) 0 (0.0) 4 (1.4) 0.35
2-year death (n, %) 1 (1.7) 10 (3.6) 0.45
1-year graft loss (n, %) 0 (0.0) 8 (2.9) 0.18
2-year graft loss (n, %) 1 (1.7) 22 (7.9) 0.08

*Conclusions: Similar rates of rejection, graft loss, infection, and cancer were observed in low risk kidney transplant recipients who received 3 mg/kg of r-ATG for induction compared to 5 mg/kg cumulative dosing.

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To cite this abstract in AMA style:

Progar K, January S, Nesselhauf N, Hagopian J, Malone A. Thymoglobulin Induction in Kidney Transplant Recipients: A Single Center Experience Comparing 3 Mg/kg vs 5 Mg/kg Cumulative Dosing [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/thymoglobulin-induction-in-kidney-transplant-recipients-a-single-center-experience-comparing-3-mg-kg-vs-5-mg-kg-cumulative-dosing/. Accessed May 11, 2025.

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