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Montero N, Rodrigo E, Crespo M, Cruzado JM, Gutierrez-Dalmau A, Mazuecos A, Sancho A, Belmar L, Calatayud E, Mora P, Oliveras L, Solà E, Villanego F, Pascual J. The use of lymphocyte-depleting antibodies in specific populations of kidney transplant recipients: A systematic review and meta-analysis. Transplant Rev (Orlando) 2023; 37:100795. [PMID: 37774445 DOI: 10.1016/j.trre.2023.100795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Recommendations of the use of antibody induction treatments in kidney transplant recipients (KTR) are based on moderate quality and historical studies. This systematic review aims to reevaluate, based on actual studies, the effects of different antibody preparations when used in specific KTR subgroups. METHODS We searched MEDLINE and CENTRAL and selected randomized controlled trials (RCT) and observational studies looking at different antibody preparations used as induction in KTR. Comparisons were categorized into different KTR subgroups: standard, high risk of rejection, high risk of delayed graft function (DGF), living donor, and elderly KTR. Two authors independently assessed the risk of bias. RESULTS Thirty-seven RCT and 99 observational studies were finally included. Compared to anti-interleukin-2-receptor antibodies (IL2RA), anti-thymocyte globulin (ATG) reduced the risk of acute rejection at two years in standard KTR (RR 0.74, 95%CI 0.61-0.89) and high risk of rejection KTR (RR 0.55, 95%CI 0.43-0.72), but without decreasing the risk of graft loss. We did not find significant differences comparing ATG vs. alemtuzumab or different ATG dosages in any KTR group. CONCLUSIONS Despite many studies carried out on induction treatment in KTR, their heterogeneity and short follow-up preclude definitive conclusions to determine the optimal induction therapy. Compared with IL2RA, ATG reduced rejection in standard-risk, highly sensitized, and living donor graft recipients, but not in high DGF risk or elderly recipients. More studies are needed to demonstrate beneficial effects in other KTR subgroups and overall patient and graft survival.
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Affiliation(s)
- Nuria Montero
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Emilio Rodrigo
- Nephrology Department, Hospital Universitario Marqués de Valdecilla/IDIVAL, Santander, Spain
| | - Marta Crespo
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Josep M Cruzado
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alex Gutierrez-Dalmau
- Nephrology Department, Hospital Universitario Miguel Servet, Aragon Health Research Institute, Zaragoza, Spain
| | | | - Asunción Sancho
- Nephrology Department, Hospital Universitari Dr Peset, FISABIO, Valencia, Spain
| | - Lara Belmar
- Nephrology Department, Hospital Universitario Marqués de Valdecilla/IDIVAL, Santander, Spain
| | - Emma Calatayud
- Nephrology Department, Hospital Universitari Dr Peset, FISABIO, Valencia, Spain
| | - Paula Mora
- Nephrology Department, Hospital Universitario Miguel Servet, Aragon Health Research Institute, Zaragoza, Spain
| | - Laia Oliveras
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Eulalia Solà
- Nephrology Department, Consorci Sanitari del Garraf, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | | | - Julio Pascual
- Nephrology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Kim HD, Bae H, Yun S, Lee H, Eum SH, Yang CW, Oh EJ, Chung BH. Impact of Induction Immunosuppressants on T Lymphocyte Subsets after Kidney Transplantation: A Prospective Observational Study with Focus on Anti-Thymocyte Globulin and Basiliximab Induction Therapies. Int J Mol Sci 2023; 24:14288. [PMID: 37762590 PMCID: PMC10532255 DOI: 10.3390/ijms241814288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Induction immunosuppressive therapy for kidney transplant recipients (KTRs) primarily includes interleukin-2 receptor antagonists, such as basiliximab (BXM) or lymphocyte-depleting agents, and anti-thymocyte globulin (ATG). This study aimed to investigate their effects on T cell dynamics during the early post-transplantation period. This prospective observational study included 157 KTRs. Peripheral blood samples were collected from each patient within 5 days before and 4 and 12 weeks after transplantation. Flow cytometric analysis was performed to assess various T cell subsets whose changes were then analyzed. In the ATG group, CD4+ T cell expression decreased significantly compared with that in the BXM group. However, CD4+CD161+ and CD4+CD25+CD127low T cell expression levels increased significantly. In the CD8+ T cell subset, a decrease in CD8+CD28nullCD57+ and CD8+CCR7+ T cell expression was observed in the ATG group. However, among patients diagnosed with biopsy-proven acute rejection, T cell subset expression did not significantly differ relative to non-rejection cases. In conclusion, ATG induction therapy resulted in more pronounced changes in T lymphocyte subsets than BXM induction, with increased CD4+CD161+ and CD4+CD25+CD127low T cells and an early decrease in CD8+CD28nullCD57+ and CD8+CCR7+ T cells, some of which are associated with acute rejection.
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Affiliation(s)
- Hyung Duk Kim
- Division of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea;
| | - Hyunjoo Bae
- Department of Biomedical Science, Graduate School, The Catholic University of Korea, Seoul 06591, Republic of Korea; (H.B.); (S.Y.)
| | - Sojeong Yun
- Department of Biomedical Science, Graduate School, The Catholic University of Korea, Seoul 06591, Republic of Korea; (H.B.); (S.Y.)
| | - Hanbi Lee
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (H.L.); (C.W.Y.)
| | - Sang Hun Eum
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Republic of Korea;
| | - Chul Woo Yang
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (H.L.); (C.W.Y.)
| | - Eun-Jee Oh
- Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Research and Development Institute for In Vitro Diagnostic Medical Devices, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Byung Ha Chung
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (H.L.); (C.W.Y.)
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Rousse J, Royer PJ, Evanno G, Lheriteau E, Ciron C, Salama A, Shneiker F, Duchi R, Perota A, Galli C, Cozzi E, Blancho G, Duvaux O, Brouard S, Soulillou JP, Bach JM, Vanhove B. LIS1, a glyco-humanized swine polyclonal anti-lymphocyte globulin, as a novel induction treatment in solid organ transplantation. Front Immunol 2023; 14:1137629. [PMID: 36875084 PMCID: PMC9978386 DOI: 10.3389/fimmu.2023.1137629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/03/2023] [Indexed: 02/18/2023] Open
Abstract
Anti-thymocyte or anti-lymphocyte globulins (ATGs/ALGs) are immunosuppressive drugs used in induction therapies to prevent acute rejection in solid organ transplantation. Because animal-derived, ATGs/ALGs contain highly immunogenic carbohydrate xenoantigens eliciting antibodies that are associated with subclinical inflammatory events, possibly impacting long-term graft survival. Their strong and long-lasting lymphodepleting activity also increases the risk for infections. We investigated here the in vitro and in vivo activity of LIS1, a glyco-humanized ALG (GH-ALG) produced in pigs knocked out for the two major xeno-antigens αGal and Neu5Gc. It differs from other ATGs/ALGs by its mechanism of action excluding antibody-dependent cell-mediated cytotoxicity and being restricted to complement-mediated cytotoxicity, phagocyte-mediated cytotoxicity, apoptosis and antigen masking, resulting in profound inhibition of T-cell alloreactivity in mixed leucocyte reactions. Preclinical evaluation in non-human primates showed that GH-ALG dramatically reduced CD4+ (p=0.0005,***), CD8+ effector T cells (p=0.0002,***) or myeloid cells (p=0.0007,***) but not T-reg (p=0.65, ns) or B cells (p=0.65, ns). Compared with rabbit ATG, GH-ALG induced transient depletion (less than one week) of target T cells in the peripheral blood (<100 lymphocytes/L) but was equivalent in preventing allograft rejection in a skin allograft model. The novel therapeutic modality of GH-ALG might present advantages in induction treatment during organ transplantation by shortening the T-cell depletion period while maintaining adequate immunosuppression and reducing immunogenicity.
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Affiliation(s)
| | | | | | | | - Carine Ciron
- Research and Development, Xenothera, Nantes, France
| | - Apolline Salama
- Nantes Université, Inserm, University Hospital Center CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Nantes, France
| | | | - Roberto Duchi
- Transplantation Immunology Unit, Padua University Hospital, Padova, Italy
| | - Andrea Perota
- Transplantation Immunology Unit, Padua University Hospital, Padova, Italy
| | - Cesare Galli
- Transplantation Immunology Unit, Padua University Hospital, Padova, Italy
| | - Emmanuele Cozzi
- Avantea, Laboratorio di Tecnologie della Riproduzione, Cremona, Italy
| | - Gilles Blancho
- Nantes Université, Inserm, University Hospital Center CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Nantes, France
| | - Odile Duvaux
- Research and Development, Xenothera, Nantes, France
| | - Sophie Brouard
- Nantes Université, Inserm, University Hospital Center CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Nantes, France
| | - Jean-Paul Soulillou
- Nantes Université, Inserm, University Hospital Center CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Nantes, France
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Gupta A, Bhalla AK, Malik M, Gupta A, Bhargava V, Tiwari V, Gaur L, Gupta P, Jain M, Rana DS. Anti-T-Lymphocyte Immunoglobulin (Grafalon) as an Induction Agent for Renal Transplantation: A Real-World, Retrospective, Single-Center Experience. EXP CLIN TRANSPLANT 2022; 20:480-486. [PMID: 35620891 DOI: 10.6002/ect.2021.0432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Polyclonal antithymocyte globulins are widely used in the induction regimens of solid-organ transplant recipients; however, their doses and outcomes remain to be standardized in Indian patients. We report our clinical experience from the real-world use of Grafalon (an anti-T-lymphocyte globulin; ATG-Fresenius) as an induction agentin renal transplant recipients from India. MATERIALS AND METHODS In this retrospective, single- center, observational study, we analyzed the medical records of 177 consecutive, kidney-only transplant recipients who received induction therapy with Grafalon from September 2016 to March 2018 at our center. Incidences of biopsy-proven acute rejection and graft dysfunction, immunosuppression protocol, Grafalon dosage, 18-month post-transplant graft and patient survival, treatment-related adverse events, and infective complications were reported. RESULTS Mean age of patients was 41.46 years (range, 14-68 years), (85% were males). The average dose of Grafalon was 5.81 ± 1.95 mg/kg (range, 2.41 to 10.07 mg/kg). Graft dysfunction (ie, at least 20% increase in serum creatinine from baseline) was observed in 26 patients (14%): 11 patients (6.2%) had biopsy-proven acute rejections, 11 patients (6.2%) had acute tubular necrosis, and 4 patients (2.2%) had calcineurin inhibitor toxicity. Seven deaths were recorded: 2 each from fungal pneumonia, bacterial pneumonia, and acute coronary syndrome and 1 with urinary tract infection with septicemia. Death-censored graft survival was 100% at 12 months and 98% at 18-month follow-up; overall patient survival was 96%. Infective complications occurred in 40 patients (22.5%), with the most common being urinary tract infection in 32 patients (18%). No malignancies were reported. CONCLUSIONS Use of a potent induction therapy like anti-T-lymphocyte globulin (Grafalon) is often restricted by the risk of side effects and lack of local clinical evidence supporting its role in long-term graft survival. Real-world evidence support the safe and effective use of anti-T-lymphocyte globulin as an induction agent in renal transplant recipients with an individualized dosing approach.
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Affiliation(s)
- Ashwani Gupta
- From the Department of Nephrology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
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Fang X, Chen S, Fu J, Liu R, Dai T, Wang D, Wu W, Yang S. Risk factors for renal allograft survival with China novel donation category: Donation after brain death followed by cardiac arrest. Transpl Immunol 2022; 72:101591. [PMID: 35364244 DOI: 10.1016/j.trim.2022.101591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION To meet the need for transplantable organs, a new donation program was initiated by the Chinese government. This novel policy created three categories for deceased organ donations: donation after circulatory death cardiac death (DCD), donation after brain death (DBD), and donation after brain death followed by circulatory death (DBCD) meaning complete cardiac arrest. In fact, the DBCD method is a combination of both DBD and DCD methods. A DBCD donor meets the criteria of for brain death, but the organ procurement begins after the withdrawal of life support and the subsequent cardiac arrest death. The purpose of this study was to evaluate the long-term outcomes of kidney transplantation in our center with the DBCD policy. Potential risk factors for affecting the renal allograft survival were also analyzed based on our data. METHOD A retrospective study, involving 421 kidney transplants derived from 214 donors, was conducted between December 2011 and October 2019. In particular, 373 (88.6%) transplanted organs met the criteria for DBCD, and 48 (11.4%) for DCD. The log-rank test was used to compare the difference in survival. The Cox regression analysis was used for risk factor screening. RESULT Analysis showed that the DBCD group was better than the DCD group in terms of overall (p = 0.031) as well as death-censored (p = 0.026) allograft survival using the log-rank test. A Cox regression analysis revealed that increasing donor age (p = 0.002, HR = 1.820/10 years incremental older), increasing recipient age (p = 0.028, HR = 1.521/10 years increment older), prolonged dialysis duration (p = 0.007, HR = 1.018), occurrence episodes of acute rejection (p = 0.016, HR = 2.697), delayed graft function (p = 0.012, HR = 2.962), mismatch ≥4 HLA loci (p = 0.038, HR = 3.606), and warm ischemia time > 15 min (p = 0.022, HR = 2.915), were all independent risk factors affecting the graft survival. CONCLUSION The new DBCD policy of donation produced acceptable results similar or even better than the DCD practice. Based on our analysis, the graft survival of DBCD transplants may be better than DCD transplants. The main risk factors for allograft loss included an increasing donor age, recipient age, warm ischemia time > 15 min, prolonged dialysis duration, acute rejection, delayed graft function, and HLA mismatch ≥4 HLA loci.
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Affiliation(s)
- Xiao Fang
- Department of Kidney Transplantation, the 900th Hospital of the People's Liberation Army Joint Service Support Force, No.156 Xi'erhuan North Road, Fuzhou 350025, China; Department of Urology, MengChao Hepatobiliary Hospital of Fujian Medical University, No.312 Xihong Road, Fuzhou 350001, China
| | - Shushang Chen
- Department of Kidney Transplantation, the 900th Hospital of the People's Liberation Army Joint Service Support Force, No.156 Xi'erhuan North Road, Fuzhou 350025, China; Department of Urology, Affiliated Tumor Hospital of Fujian medical university, Fujian Provincial Tumor Hospital, Fuzhou 350011, Fujian, China
| | - Junmin Fu
- Department of Kidney Transplantation, the 900th Hospital of the People's Liberation Army Joint Service Support Force, No.156 Xi'erhuan North Road, Fuzhou 350025, China
| | - Rong Liu
- Department of Kidney Transplantation, the 900th Hospital of the People's Liberation Army Joint Service Support Force, No.156 Xi'erhuan North Road, Fuzhou 350025, China
| | - Tianzeng Dai
- Department of Kidney Transplantation, the 900th Hospital of the People's Liberation Army Joint Service Support Force, No.156 Xi'erhuan North Road, Fuzhou 350025, China; Fuzong Clinical Medical College of Fujian Medical University, No.156 Xi'erhuan North Road, Fuzhou 350025, China
| | - Dong Wang
- Department of Kidney Transplantation, the 900th Hospital of the People's Liberation Army Joint Service Support Force, No.156 Xi'erhuan North Road, Fuzhou 350025, China; Fuzong Clinical Medical College of Fujian Medical University, No.156 Xi'erhuan North Road, Fuzhou 350025, China
| | - Weizhen Wu
- Department of Kidney Transplantation, the 900th Hospital of the People's Liberation Army Joint Service Support Force, No.156 Xi'erhuan North Road, Fuzhou 350025, China; Fuzong Clinical Medical College of Fujian Medical University, No.156 Xi'erhuan North Road, Fuzhou 350025, China.
| | - Shunliang Yang
- Department of Kidney Transplantation, the 900th Hospital of the People's Liberation Army Joint Service Support Force, No.156 Xi'erhuan North Road, Fuzhou 350025, China; Fuzong Clinical Medical College of Fujian Medical University, No.156 Xi'erhuan North Road, Fuzhou 350025, China.
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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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George J, Gracious N, Gopal A, Balan S, Murlidharan P, Gopalakrishnan S, Potty V, Kurup S. Low-dose induction immunosuppression in deceased donor kidney transplantation during coronavirus disease pandemic - A multicentric prospective observational study. INDIAN JOURNAL OF TRANSPLANTATION 2021. [DOI: 10.4103/ijot.ijot_111_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Gierczak V, Jouve T, Malvezzi P, Terrec F, Naciri-Bennani H, Janbon B, Rostaing L, Noble J. Impact of Immunosuppressive Strategies on Post-Kidney Transplantation Thrombocytopenia. Transplant Proc 2020; 53:941-949. [PMID: 33121819 DOI: 10.1016/j.transproceed.2020.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/11/2020] [Accepted: 09/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Thrombocytopenia after kidney transplantation is a common complication, partly induced by immunosuppressive therapies. Peritransplant thrombocytopenia may cause serious hemorrhages. We assessed the incidence of early posttransplantation thrombocytopenia (defined as a platelet count of <150,000 mm3 or <150 G/L) in de novo kidney transplant recipients (KTRs) across 4 immunosuppressive regimens. METHODS This was a single-center observational study that included all consecutive KTRs who received either Thymoglobulin (THY) or Grafalon (GRA) and maintenance therapy of either mycophenolate-mofetil (MMF) or everolimus (EVR), associated with tacrolimus/corticosteroids. RESULTS Between July 27, 2016, and September 7, 2018, 237 KTRs were included; 64.6% experienced thrombocytopenia within the first week. Thrombocytopenia was significantly more frequent (P = .004) among GRA-treated patients (73.4%) compared to THY-treated patients (61.3%). These patients also had lower nadir platelet count (120 ± 52 vs 142 ± 48 G/L; P = .002) and lower platelet count at discharge (227 ± 94 vs 243 ± 92 G/L; P = .25). More of the GRA-EVR group had thrombocytopenia (81.0% vs 61.4% in THY-MMF, 60.9% in THY-EVR, and 69.8% in GRA-MMF; P = .081) and a worse nadir platelet count (109 ± 41 in GRA-EVR vs 141 ± 47G/L in THY-MMF, 145 ± 52 G/L in THY-EVR, and 125 ± 56 G/L in GRA-MMF; P = .011) but GRA was the only risk factor for thrombocytopenia in multivariate analyses (P = .002). Rates of hemorrhage, red blood cell transfusions, reoperations needed within the first week, delayed graft function, acute rejection, graft loss, and death did not differ between the groups after a mean follow-up of 25 ± 8 months. CONCLUSIONS GRA associated with EVR led to more frequent and severe thrombocytopenia, although we found no significant clinical consequences.
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Affiliation(s)
- Valentine Gierczak
- Nephrology Department, Hémodialyse, Apheresis and Renal Transplantation, CHU Grenoble-Alpes, Grenoble, France; Grenoble Alpes University, Grenoble, France
| | - Thomas Jouve
- Nephrology Department, Hémodialyse, Apheresis and Renal Transplantation, CHU Grenoble-Alpes, Grenoble, France; Grenoble Alpes University, Grenoble, France
| | - Paolo Malvezzi
- Nephrology Department, Hémodialyse, Apheresis and Renal Transplantation, CHU Grenoble-Alpes, Grenoble, France
| | - Florian Terrec
- Nephrology Department, Hémodialyse, Apheresis and Renal Transplantation, CHU Grenoble-Alpes, Grenoble, France
| | - Hamza Naciri-Bennani
- Nephrology Department, Hémodialyse, Apheresis and Renal Transplantation, CHU Grenoble-Alpes, Grenoble, France
| | - Benedicte Janbon
- Nephrology Department, Hémodialyse, Apheresis and Renal Transplantation, CHU Grenoble-Alpes, Grenoble, France
| | - Lionel Rostaing
- Nephrology Department, Hémodialyse, Apheresis and Renal Transplantation, CHU Grenoble-Alpes, Grenoble, France; Grenoble Alpes University, Grenoble, France.
| | - Johan Noble
- Nephrology Department, Hémodialyse, Apheresis and Renal Transplantation, CHU Grenoble-Alpes, Grenoble, France
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Cheon SU, Moon JI, Choi IS, Yoon SH, Hwang WM, Yun SR. Comparison of the Clinical Outcomes between Anti-thymocyte Globulin and Basiliximab Induction Therapy in Deceased Donor Kidney Transplantation: Single Center Experience. KOREAN JOURNAL OF TRANSPLANTATION 2015. [DOI: 10.4285/jkstn.2015.29.2.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Seong Uk Cheon
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Ju Ik Moon
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - In Seok Choi
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Se Hee Yoon
- Department of Internal Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Won Min Hwang
- Department of Internal Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Sung Ro Yun
- Department of Internal Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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Shang W, Dong L, Feng G, Wang Y, Pang X, Li J, Liu L, Zhang W. Panel-reactive antibody levels and renal transplantation rates in sensitized patients after desensitization and human leucocyte antigen amino acid residue matching. J Int Med Res 2013; 41:1333-41. [PMID: 23780877 DOI: 10.1177/0300060513485896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine whether a new desensitization protocol (mycophenolate mofetil [MMF], plasmapheresis and antithymocyte globulin [ATG], complemented with human leucocyte antigen [HLA] amino acid residue matching) could reduce panel-reactive antibody (PRA) levels in sensitized patients, to facilitate successful renal transplantation. METHODS Patients awaiting transplantation with PRA levels >10% received treatment with MMF; those with PRA levels >30% were also treated with plasmapheresis. Patients whose PRA level was <20% after desensitization were eligible for transplantation. When a donor became available, traditional HLA matching and HLA amino acid residue matching were performed. All patients received ATG induction therapy postoperatively. RESULTS Thirty-two sensitized patients were enrolled. Desensitization produced a significant decrease in PRA levels; 27 patients (84.4%) became eligible for transplantation and 26 (81.2%) subsequently underwent successful transplantation. Residue matching improved the proportion with a mismatch number of 0-1 from 7.7% to 65.4%, compared with traditional HLA matching. Postoperatively, all patients showed immediate graft function. Acute rejection occurred in three patients (11.5%) and infections in seven patients (25.9%); all were treated successfully. CONCLUSION The combination of a desensitization protocol (MMF, plasmapheresis and ATG) and residue matching appears to be an effective strategy for sensitized patients awaiting renal transplantation.
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Affiliation(s)
- Wenjun Shang
- Department of Renal Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Ulrich F, Niedzwiecki S, Pascher A, Kohler S, Weiss S, Fikatas P, Schumacher G, May G, Reinke P, Neuhaus P, Tullius SG, Pratschke J. Long-term outcome of ATG vs. Basiliximab induction. Eur J Clin Invest 2011; 41:971-8. [PMID: 21382021 DOI: 10.1111/j.1365-2362.2011.02490.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND An evaluation of the long-term efficacy and incidence of adverse events after induction therapy with antithymocyte globulin (ATG) vs. Basiliximab in renal transplant patients. METHODS Sixty recipients receiving ATG induction and a dual immunosuppression with Tacrolimus and steroids were compared retrospectively with 60 patients treated with Basiliximab. The following characteristics were evaluated: concomitant immunosuppression, recipient age, donor age, time on dialysis, cold ischemia time, year of transplantation and HLA mismatches. RESULTS The 6-year patient survival in the ATG group was 91·7% compared to 85% in the Basiliximab group (not significant, n.s.). Graft survival at 6 years was 89·7% and. 83·6% in the ATG and the Basiliximab group (n.s.), respectively. Incidence of biopsy proven acute rejection episodes (33·3% vs. 26·7%) and delayed graft function (30% vs. 33·3%) were similar in both groups. Kidney function was not significantly different at 1 and 6 years. CMV infections were more prevalent in the ATG arm (22% vs. 5%; P = 0·05), and a significantly higher rate of haematological complications was observed following ATG induction. CONCLUSIONS ATG induction was associated with an improved (but n.s.) trend in patient and graft survival. Patients induced with ATG had a higher rate of CMV infections and haematological complications.
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Affiliation(s)
- Frank Ulrich
- Department of Visceral, General and Transplantation Surgery, Charité Universitätsmedizin Berlin, Germany.
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Liu Y, Zhou P, Han M, Xue CB, Hu XP, Li C. Basiliximab or antithymocyte globulin for induction therapy in kidney transplantation: a meta-analysis. Transplant Proc 2010; 42:1667-70. [PMID: 20620496 DOI: 10.1016/j.transproceed.2010.02.088] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 01/18/2010] [Accepted: 02/02/2010] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare efficacy and safety of basiliximab versus antithymocyte globulin (ATG) for induction therapy in kidney transplantation. METHODS A literature search of the MEDLINE, EMBASE, CBMdisc, and Cochrane databases was used to identify randomized controlled trials that compared basiliximab and ATG for induction therapy in kidney transplantation. Inclusion criteria comprised: prospective randomized controlled clinical trials, follow-up time >or=12 months, randomized comparisons of ATG versus basiliximab as induction therapy in kidney transplantation. Meta-analytical techniques were applied to identify differences in outcomes between the two agents. RESULTS A total of six studies involving 853 patients were identified. No differences between ATG and basiliximab were seen in terms of biopsy-proven rejection (relative risk [RR] 1.15, 95% confidence interval [CI] 0.88-1.52, P = .31), delayed graft function (RR 1.02, 95% CI 0.69-1.51, P = .93), graft loss (RR 1.15, 95% CI 0.73-1.80, P = .55), and patient death (RR 1.22, 95% CI 0.65-2.30, P = .54). But basiliximab had a lower incidence of infection (RR 0.87, 95% CI 0.78-0.97, P = .02) and neoplasm (RR 0.29, 95% CI 0.09-0.97, P = .04). CONCLUSIONS Basiliximab is as effective as ATG for induction therapy in kidney transplantation, whereas basiliximab has a lower incidence of infection. Basiliximab may be a safer and preferable option for induction therapy in kidney transplantation.
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Affiliation(s)
- Y Liu
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, China
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Wang D, Wu WZ, Chen JH, Yang SL, Wang QH, Zeng ZX, Tan JM. Pre-transplant soluble CD30 level as a predictor of not only acute rejection and graft loss but pneumonia in renal transplant recipients. Transpl Immunol 2010; 22:115-20. [DOI: 10.1016/j.trim.2009.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 11/18/2009] [Accepted: 12/08/2009] [Indexed: 10/20/2022]
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15
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Boillot O, Seket B, Dumortier J, Pittau G, Boucaud C, Bouffard Y, Scoazec JY. Thymoglobulin induction in liver transplant recipients with a tacrolimus, mycophenolate mofetil, and steroid immunosuppressive regimen: a five-year randomized prospective study. Liver Transpl 2009; 15:1426-34. [PMID: 19877264 DOI: 10.1002/lt.21905] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This randomized, comparative study assessed the long-term efficacy and tolerability of thymoglobulin (TMG) induction in 93 liver transplant patients with an initial regimen of tacrolimus (Tac), mycophenolate mofetil (MMF), and steroids. Forty-four patients were randomly allocated to the TMG+ group, and 49 patients were randomly allocated to the TMG- group. In both groups, Tac was given orally at the initial daily dose of 0.075 mg/kg twice daily, and MMF was given at the initial daily dose of 2 g/day. Steroid withdrawal was planned at 3 months after liver transplantation. The results were evaluated with respect to acute rejection incidence, patient and graft survival, graft function, and medical complications until 5 years or death for all patients. No significant differences were found between groups for the incidence of acute rejection at 5 years (11.4% versus 14.3%), 5-year patient survival (77.3% versus 87.8%), graft function, or postoperative renal function. One patient in the TMG- group underwent retransplantation. There was no difference between groups with respect to the incidence of medical complications, excepted for a higher rate of leukopenia in the TMG+ group, during the 5-year follow-up. In conclusion, the results of this prospective randomized study suggest that the addition of TMG to a triple immunosuppressive regimen (Tac, MMF, and steroids) did not modify the incidence of acute rejection episodes or long-term survival and was responsible for increased leukopenia rates.
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Affiliation(s)
- Olivier Boillot
- Liver Transplant Unit, Edouard Herriot Hospital, Lyon, France.
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Salvana EMT, Salata RA. Infectious complications associated with monoclonal antibodies and related small molecules. Clin Microbiol Rev 2009; 22:274-90, Table of Contents. [PMID: 19366915 PMCID: PMC2668229 DOI: 10.1128/cmr.00040-08] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Biologics are increasingly becoming part of routine disease management. As more agents are developed, the challenge of keeping track of indications and side effects is growing. While biologics represent a milestone in targeted and specific therapy, they are not without drawbacks, and the judicious use of these "magic bullets" is essential if their full potential is to be realized. Infectious complications in particular are not an uncommon side effect of therapy, whether as a direct consequence of the agent or because of the underlying disease process. With this in mind, we have reviewed and summarized the risks of infection and the infectious disease-related complications for all FDA-approved monoclonal antibodies and some related small molecules, and we discuss the probable mechanisms involved in immunosuppression as well as recommendations for prophylaxis and treatment of specific disease entities.
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Affiliation(s)
- Edsel Maurice T Salvana
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, Ohio 44106-5083, USA
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Wang D, Xu TZ, Chen JH, Wu WZ, Yang SL, Lin WH, Cai JQ, Tan JM. Factors influencing second renal allograft survival: a single center experience in China. Transpl Immunol 2008; 20:150-4. [PMID: 18848988 DOI: 10.1016/j.trim.2008.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 09/11/2008] [Accepted: 09/18/2008] [Indexed: 11/19/2022]
Abstract
Second renal transplants are historically associated with a poor prognosis. The aim of the present study was to assess long-term survival of second renal grafts from deceased donors performed at our center and to analyze risk factors associated with long-term graft outcome. Sixty-five second renal grafts were enrolled into this study, and compared to primary ones performed during the same period. Kaplan-Meier curve showed a graft survival rate of 89.2% at 1 year, 80% at 3 years, and 63.1% at 5 years, which were similar to that of primary graft. Univariate analysis showed that time to first graft loss, cold ischaemia time, HLA mismatch, primary maintenance immunosuppressant, acute rejection episodes, and serum creatinine at 1 year were significantly associated with regraft survival. Cox regression demonstrated the dominant effect of acute rejection episodes, primary maintenance immunosuppressant, serum creatinine at 1 year, and time to first graft loss as predictor of second graft outcome. However, when long-term survival of second graft was examined on the basis of Kaplan-Meier estimates, HLA mismatch was found to be significant. The second graft had more benefits of improved pre-transplant screening and post-transplant management, and its survival rate was satisfactory and similar to that of primary one. Immunologic factors such as acute rejection and primary immunosuppressant are the main determinants of long-term renal transplantation outcome.
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Affiliation(s)
- Dong Wang
- Organ Transplant Institute, Fuzhou general Hospital, Fuzhou 350025, China
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