Efficacy Of Anti-T-lymphocyte Globulin-Fresenius As An Induction Agent In Deceased-Donor Renal Transplantation:A Cohort Study

ObjectiveProlonging kidney transplant survival is an important clinical priority.Induction immunosuppression with antibody therapy is recommended at transplantation.Induction immunosuppression therapy is used to support optimal outcomes in kidney transplantation.Anti-T-lymphocyte globulin-Fresenius(ATG-F),Basiliximab and Anti-T-lymphocyte globulin(ATG)are frequently used in the induction regimen of renal transplantation.These three kinds of antibodies are given before renal transplantation to reduce the incidence of acute rejection(AR)and reduce the risk of chronic graft-versus-host disease(cGVHD).Although basiliximab and anti-thymocyte globulin(ATG)are frequently used in the induction regimen of kidney transplantation and are effective in delaying and reducing the incidence of acute rejection(AR)thus improving graft survival,their dosages have not been standardized.We evaluated the efficacy of different ATG-Fresenius(ATG-F)doses in recipients of renal transplantation.MethodA total of 131 adult recipients of renal transplantation who received ATG-F induction between August 1,2015 and July 31,2018 in the Department of Kidney Transplantation,Affiliated Hospital of Qingdao University were included.According to the cumulative dose of inducer,they are divided into two groups:cumulative ATG-F dose<7 mg/kg and cumulative ATG-F dose?7 mg/kg.Participants in the two dose groups were well matched with regard to demographics and immunological risk factors aside from by body weight and body mass index.We compared categorical variables using the?~2 test and the categorical variables include the age,sex,cause of death,and duration of ischemia of organ donors in the two-dose groups.We used the Student's unpaired t-test and the one-way analysis of variance to assess the incidence of biopsy-confirmed acute rejection,graft function,graft and patient survival within12 months post-transplant,and side effects including hematologic and infection-related ones among those receiving a cumulative ATG-F dose<7 mg/kg and?7 mg/kg.Continuous variables are expressed as the mean±the standard deviation.A P-value<0.05 was deemed significant.ResultThe incidence of biopsy-confirmed acute rejection was similar between those receiving cumulatively<7 and?7 mg/kg(the former vs.the latter,7.5%vs.4.7%,p=0.766).The incidence of infection within 12 months was lower in the ATG-F<7 mg/kg group compared to?7 mg/kg group(26.9%vs.50.0%,p=0.006),but the incidence of pneumonia did not differ between the ATG-F<7 and?7 mg/kg groups(10.4%vs 20.3%,p=0.117).The incidence of urinary infection was higher in the?7 mg/kg group than the<7 mg/kg group(20.4%vs.7.46%,p=0.033),while the extent and duration of anemia and lymphopenia was similar between groups.There was no difference in graft function,delayed graft function,overall,and graft survival between groups.ConclusionATG-F has been widely used as an inducer for allograft kidney transplantation for decades,but the optimal dosage is still unknown.This study showed that a moderate reduction in cumulative ATG-F doses was not associated with an increased risk of acute rejection,while the risk of infection was reduced.Therefore,the optimization of ATG-F dose for induction could facilitate the reduction of infection risk without compromising induction efficacy in renal transplant recipients.