Abstract
BackgroundLiterature on the timing of rabbit antithymocyte globulin (rATG) induction and its effects on kidney transplant outcomes is limited. The manufacturer recommends that the first dose be given intra-operatively, however this may present clinical practice risks and challenges. Our objective was to assess the impact of the timing of the first dose of rATG on kidney transplant outcomes.MethodsIncident kidney transplant recipients (KTR) from January 2002 to December 2009 receiving the first dose of rATG post-operatively (Post, n = 353) or before reperfusion (Pre, n = 124) were evaluated. Outcomes assessed included eGFR at 1-year, delta eGFR (12 versus 1 month), and incidence of biopsy-proven acute rejection, graft loss, death, and a composite of the time-to-event outcomes. The impact of timing on outcomes was adjusted for potential confounders and assessed using linear and Cox regression models.ResultsAmong 435 KTR surviving with function to 12 months post-transplant, there was no significant difference in mean estimated glomerular filtration rate or eGFR (55.0 versus 56.7 mL/min, P = 0.46) and delta eGFR (1.8 versus 0.3 mL/min, P = 0.40) in Post versus Pre groups, respectively. At a median follow-up of 3 years, the composite endpoint (time to first biopsy-proven acute rejection, graft loss, or death) was similar by timing group (adjusted HR = 0.94; 95% CI: 0.58, 1.53, P = 0.81) in the total study population.ConclusionsTiming of rATG had no appreciable impact on clinically relevant endpoints in this study cohort. These results support consideration of more flexible timing of the first dose of rATG induction in KTR.
Highlights
Literature on the timing of rabbit antithymocyte globulin induction and its effects on kidney transplant outcomes is limited
Rabbit antithymocyte globulin is a polyclonal gamma immunoglobulin derived from the immunization of rabbits with human thymocytes and indicated for the prevention and treatment of acute kidney transplant rejection [1]
The question of timing of first dose of rabbit antithymocyte globulin (rATG) induction is relevant in clinical practice since operational factors may favor postoperative administration
Summary
Literature on the timing of rabbit antithymocyte globulin (rATG) induction and its effects on kidney transplant outcomes is limited. [2,3] Adverse events such as fever, chills and gastrointestinal distress are more frequent with rATG than with other induction agents [4,5]. Serious reactions such as cytokine release syndrome with hemodynamic instability can occur and are most commonly associated with the first dose and rapid infusion rates [1]. The question of timing of first dose of rATG induction is relevant in clinical practice since operational factors may favor postoperative administration. Adverse drug events resulting from medication error occur commonly in the peri-operative setting and are a major cause of morbidity and mortality [7]
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