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Gang S, Gulati S, Bhalla AK, Varma PP, Bansal R, Abraham A, Ray DS, John MM, Bansal SB, Sharma RK, Vishwanath S. One-Year Outcomes with Use of Anti-T-Lymphocyte Globulin in Patients Undergoing Kidney Transplantation: Results from a Prospective, Multicentric, Observational Study from India. Adv Ther 2022; 39:4533-4541. [PMID: 35817945 PMCID: PMC9464724 DOI: 10.1007/s12325-022-02225-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/14/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Large-scale Indian data on the use of anti-T-lymphocyte globulin (ATLG) (Grafalon®) as induction therapy in kidney transplantation (KT) patients is lacking. The aim of this study was to determine the 1-year patient and graft survival outcomes with the use of ATLG as induction regimen in KT. METHODS In a prospective, multicentric, observational study, adult patients who underwent ABO-compatible KT and had received ATLG as a part of induction were included in the study. The primary outcome measure was overall survival and death-censored graft survival at 12 months. The primary safety outcome was assessed by development of infectious complications and graft rejection. RESULTS In total, 359 patients were included in this study. The mean age was 42.77 ± 12.30 years and 83% were male. The average ATLG dose per patient was 6.2 ± 2.2 mg/kg whereas average cumulative dose per patient was 389.6 ± 149.8 mg. The rate of graft dysfunction was 13.4% of patients and 6.7% had biopsy-proven acute rejection (BPAR). There were a total of 12 (3.3%) deaths and one graft loss. Overall survival and death-censored graft survival at 12 months were 96.65% and 99.44%, respectively. The rate of infections was 13.6% with urinary tract infections being most common. CONCLUSION ATLG at an average dose of 6 mg/kg is an effective and safe induction regimen immunosuppressant for ABO-compatible KT with favourable impact on survival and graft function in Indian patients.
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Affiliation(s)
- Sishir Gang
- grid.416255.10000 0004 1768 1324Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat India
| | - Sanjeev Gulati
- Department of Nephrology, Fortis and Escorts Group of Hospitals, NCR, New Delhi, India
| | - Anil K. Bhalla
- grid.415985.40000 0004 1767 8547Department of Nephrology, Sir Gangaram Hospital, Rajinder Nagar, New Delhi, India
| | - Prem P. Varma
- Department of Nephrology, Venkateshwar Hospital, New Delhi, India
| | - Ravi Bansal
- grid.418817.30000 0004 1800 339XDepartment of Nephrology, PSRI Hospital, New Delhi, India
| | - Abi Abraham
- grid.415772.20000 0004 1770 5752Department of Nephrology, Lakeshore Hospital and Research Centre Ltd, Ernakulam, Kerala India
| | - Deepak S. Ray
- grid.496646.f0000 0004 1806 0407Department of Nephrology, NH Rabindranath Tagore International Institute of Cardiac Sciences, Eastern Metropolitan Bypass, Mukundapur, Kolkata India
| | - Mammen M. John
- grid.412936.b0000 0004 1766 1286Department of Nephrology, Medical Trust Hospital, Pallimukku, Kochi, Kerala India
| | - Shyam B. Bansal
- Medanta’s Institute of Nephrology and Kidney Transplant, Gurgaon, India
| | | | - S. Vishwanath
- grid.416383.b0000 0004 1768 4525Department of Nephrology, Manipal Hospital, Bengaluru, India
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Jha PK, Rana A, Kher A, Bansal SB, Sethi S, Nandwani A, Jain M, Bansal D, Yadav DK, Gadde A, Mahapatra AK, Sodhi P, Kher V. Grafalon® vs. Thymoglobulin® as an Induction Agent in Renal Transplantation - A Retrospective Study. Indian J Nephrol 2021; 31:336-340. [PMID: 34584347 PMCID: PMC8443089 DOI: 10.4103/ijn.ijn_205_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/16/2020] [Accepted: 07/28/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Antihuman thymocyte immunoglobulin, used as an induction agent in renal transplantation, is of two types - thymoglobulin and grafalon (formerly ATG-Fresenius). In this study, we compared outcomes with these two agents. Methods This was a single-center retrospective study of patients transplanted from January 2017 to October 2019, who received either grafalon or thymoglobulin induction. Grafalon or thymoglobulin was given at 6 and 3 mg/kg, respectively, followed by standard triple immunosuppression of tacrolimus, MMF, and prednisolone. Results Median follow up was 22 (3-36) months. Thymoglobulin was given to 255 patients, whereas 78 patients received grafalon. Baseline demographics were similar between the two groups although significantly more patients in the grafalon group received ABO incompatible transplant (15% vs. 4.3%; P = 0.002). Patient survival was similar between the two groups (99% in grafalon vs. 98.8% in thymoglobulin; P = 1.0). Death censored graft survival was also similar (99% in grafalon vs. 100% in thymoglobulin; P = 0.23). Biopsy proven acute rejection (BPAR) was significantly higher in the grafalon group (12.8% vs. 5.1%, P = 0.04). The significance persisted after multivariable regression analysis (P = 0.02). Other outcomes such as infection rate and estimated glomerular filtration rate on last follow up were comparable between the two groups. Conclusions Grafalon (6 mg/kg dose) when used as an induction agent was associated with significantly higher rate of BPARs as compared to thymoglobulin (3 mg/kg dose) although with comparable short-term patient and death censored graft survival, graft function, and infection rates.
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Affiliation(s)
- Pranaw Kumar Jha
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta - The Medicity, Sector 38, Gurugram, Haryana, India
| | - Abhyudaysingh Rana
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta - The Medicity, Sector 38, Gurugram, Haryana, India
| | - Ajay Kher
- Department of Nephrology, Max Super Specialty Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India
| | - Shyam Bihari Bansal
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta - The Medicity, Sector 38, Gurugram, Haryana, India
| | - Sidharth Sethi
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta - The Medicity, Sector 38, Gurugram, Haryana, India
| | - Ashish Nandwani
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta - The Medicity, Sector 38, Gurugram, Haryana, India
| | - Manish Jain
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta - The Medicity, Sector 38, Gurugram, Haryana, India
| | - Dinesh Bansal
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta - The Medicity, Sector 38, Gurugram, Haryana, India
| | - Dinesh Kumar Yadav
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta - The Medicity, Sector 38, Gurugram, Haryana, India
| | - Ashwini Gadde
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta - The Medicity, Sector 38, Gurugram, Haryana, India
| | - Amit Kumar Mahapatra
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta - The Medicity, Sector 38, Gurugram, Haryana, India
| | - Puneet Sodhi
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta - The Medicity, Sector 38, Gurugram, Haryana, India
| | - Vijay Kher
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta - The Medicity, Sector 38, Gurugram, Haryana, India
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