TY - JOUR
T1 - Rabbit antithymocyte induction and dosing in deceased donor renal transplant recipients over 60yr of age
AU - Patel, Samir J.
AU - Knight, Richard J.
AU - Suki, Wadi N.
AU - Abdellatif, Abdul
AU - Duhart, Benjamin T.
AU - Krauss, Amy G.
AU - Mannan, Saurabh
AU - Nezakatgoo, Nosratollah
AU - Gaber, A. Osama
N1 - Copyright:
Copyright 2011 Elsevier B.V., All rights reserved.
PY - 2011/5
Y1 - 2011/5
N2 - Background: Antithymocyte globulin (rATG) is a commonly used induction agent in renal transplantation; however, data in older kidney recipients are limited. Methods: We reviewed charts of 301 deceased donor renal transplants who received a protocol consisting of 3-7 doses of rATG and triple maintenance therapy. Outcomes of patients >60yr of age (n=45) were compared to those aged 18-59yr (n=256). Results: Older recipients had more diabetics, were more likely to receive expanded criteria donor kidneys (p<0.01), and over 30% were sensitized. Recipients >60 received less cumulative rATG (4.6 vs. 5.1mg/kg; p<0.01). Three-yr acute rejection was lower in the >60 group (2% vs. 16%, p<0.01) although glomerular filtration rates were similar between groups. Actuarial graft survival was similar; however, patient survival in the >60 group at threeyr was lower (80% vs. 95%; p=0.02). Specifically, patients >60 with delayed graft function and rATG cumulative dosing >6mg/kg had a survival of <50% by twoyr. Conclusion: Recipients over 60yr receiving rATG induction have acceptable renal function and a low risk of rejection; however, reduced survival was noted among those receiving >6mg/kg. These data suggest that when used, lower cumulative dosages of rATG are preferable in the older recipient.
AB - Background: Antithymocyte globulin (rATG) is a commonly used induction agent in renal transplantation; however, data in older kidney recipients are limited. Methods: We reviewed charts of 301 deceased donor renal transplants who received a protocol consisting of 3-7 doses of rATG and triple maintenance therapy. Outcomes of patients >60yr of age (n=45) were compared to those aged 18-59yr (n=256). Results: Older recipients had more diabetics, were more likely to receive expanded criteria donor kidneys (p<0.01), and over 30% were sensitized. Recipients >60 received less cumulative rATG (4.6 vs. 5.1mg/kg; p<0.01). Three-yr acute rejection was lower in the >60 group (2% vs. 16%, p<0.01) although glomerular filtration rates were similar between groups. Actuarial graft survival was similar; however, patient survival in the >60 group at threeyr was lower (80% vs. 95%; p=0.02). Specifically, patients >60 with delayed graft function and rATG cumulative dosing >6mg/kg had a survival of <50% by twoyr. Conclusion: Recipients over 60yr receiving rATG induction have acceptable renal function and a low risk of rejection; however, reduced survival was noted among those receiving >6mg/kg. These data suggest that when used, lower cumulative dosages of rATG are preferable in the older recipient.
KW - Antibody induction
KW - Elderly
KW - Kidney transplantation
KW - Rabbit antithymocyte globulin
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U2 - 10.1111/j.1399-0012.2010.01393.x
DO - 10.1111/j.1399-0012.2010.01393.x
M3 - Article
C2 - 21231963
AN - SCOPUS:79958747834
VL - 25
SP - E250-E256
JO - Clinical Transplantation
JF - Clinical Transplantation
SN - 0902-0063
IS - 3
ER -