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. 2021 Feb;34(2):339-352.
doi: 10.1111/tri.13800. Epub 2020 Dec 31.

Decreased incidence of acute rejection without increased incidence of cytomegalovirus (CMV) infection in kidney transplant recipients receiving rabbit anti-thymocyte globulin without CMV prophylaxis - a cohort single-center study

Mayara Ivani de Paula  1   2 , Mary Grace Bowring  2 , Ashton A Shaffer  2   3 , Jacqueline Garonzik-Wang  2 , Adrieli Barros Bessa  1 , Claudia Rosso Felipe  1 , Marina Pontello Cristelli  1 , Allan B Massie  2   3 , Jose Medina-Pestana  1 , Dorry L Segev  2   3 , Helio Tedesco-Silva  1
Affiliations

Decreased incidence of acute rejection without increased incidence of cytomegalovirus (CMV) infection in kidney transplant recipients receiving rabbit anti-thymocyte globulin without CMV prophylaxis - a cohort single-center study

Mayara Ivani de Paula et al. Transpl Int. 2021 Feb.

Abstract

Induction therapy with rabbit anti-thymocyte globulin (rATG) in low-risk kidney transplant recipients (KTR) remains controversial, given the associated increased risk of cytomegalovirus (CMV) infection. This natural experiment compared 12-month clinical outcomes in low-risk KTR without CMV prophylaxis (January/3/13-September/16/15) receiving no induction or a single 3 mg/kg dose of rATG. We used logistic regression to characterize delayed graft function (DGF), negative binomial to characterize length of hospital stay (LOS), and Cox regression to characterize acute rejection (AR), CMV infection, graft loss, death, and hospital readmissions. Recipients receiving 3 mg/kg rATG had an 81% lower risk of AR (aHR 0.14 0.190.25 , P < 0.001) but no increased rate of hospital readmissions because of infections (0.68 0.911.21 , P = 0.5). There was no association between 3 mg/kg rATG and CMV infection/disease (aHR 0.86 1.101.40 , P = 0.5), even when the analysis was stratified according to recipient CMV serostatus positive (aHR 0.94 1.251.65 , P = 0.1) and negative (aHR 0.28 0.571.16 , P = 0.1). There was no association between 3 mg/kg rATG and mortality (aHR 0.51 1.253.08 , P = 0.6), and graft loss (aHR 0.34 0.731.55 , P = 0.4). Among low-risk KTR receiving no CMV pharmacological prophylaxis, 3 mg/kg rATG induction was associated with a significant reduction in the incidence of AR without an increased risk of CMV infection, regardless of recipient pretransplant CMV serostatus.

Keywords: CMV infection; acute rejection; low immunological risk; thymoglobulin.

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Conflict of interest statement

Conflict of interest

The following authors of this manuscript have conflicts of interest to disclose: Helio Tedesco-Silva has received speaker’s fees and travel or accommodation expenses for development of educational presentations and scientific advice from Novartis, Pfizer, and Roche. Jose Medina Pestana has received speaker’s fees and travel or accommodation expenses for development of educational presentations and scientific advice from Bristol-Myers Squibb, Novartis, Pfizer, and Roche. Claudia Felipe has received speaker’s fees for development of educational presentations and travel or accommodation expenses from Novartis and Pfizer. Marina Cristelli has received speaker’s fees for development of educational presentations and travel or accommodation expenses from Novartis and Pfizer. Dorry Segev receives speaking honoraria from Sanofi. The other authors of this manuscript have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Disposition of the study population.
Figure 2
Figure 2
Cumulative incidence of (a) treated acute rejection and (b) biopsy-proven acute rejection in the first year after kidney transplant in low-risk recipients who received rATG 3 m/kg compared with those who received no induction.
Figure 3
Figure 3
Cumulative incidence of CMV infections according to pretransplant recipient CMV serostatus (a) positive and (b) negative in low-risk recipients who received rATG 3 m/kg compared with those who received no induction.
Figure 4
Figure 4
Mortality (a) and death-censored graft failure (b) in low-risk recipients who received rATG 3 m/kg compared with those who received no induction.
See this image and copyright information in PMC

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