ATG-Fresenius increases the risk of red blood cell transfusion after kidney transplantation

Abstract

Introduction: In sensitized deceased donor kidney allograft recipients, the most frequent induction therapy is anti-thymocyte globulins (ATG), including Thymoglobulin® (Thymo) and ATG-Fresenius (ATG-F).

Methods: We conducted a 3-year monocentric observational study to compare the impact of ATGs on hematological parameters. We included adult kidney transplant recipients treated with ATG induction therapy, either Thymo or ATG-F, on a one-in-two basis. The primary endpoint was red blood cell (RBC) transfusions within 14 days after transplantation.

Results: Among 309 kidney allograft recipients, 177 (57.2%) received ATG induction, 90 (50.8 %) ATG-F, and 87 (49.2%) Thymo. The ATG-F group received significantly more RBC transfusions (63.3% vs. 46% p = 0.02) and in bigger volumes (p = 0.01). Platelet transfusion was similar in both groups. Within 14 and 30 days after transplantation, older age, ATG-F induction, and early surgical complication were independently associated with RBC transfusion. Patient survival rate was 95%, and the death-censored kidney allograft survival rate was 91.5% at 12 months post-transplantation. There was no difference in the incidence of acute rejection and infections or in the prevalence of anti-HLA donor-specific antibodies.

Discussion: In conclusion, after kidney transplantation, ATG-F is an independent risk factor for early RBC transfusion and early thrombocytopenia without clinical and biological consequences. These new data should be clinically considered, and alternatives to ATG should be further explored.

Keywords: anti-thymocyte globulins; donor-specific anti-HLA antibodies; induction therapy; kidney transplantation; red blood cell transfusion.

Figure 1

Among the 309 kidney allograft recipients engrafted between January 2016 and August 2018, 177 (57.2%) received anti-thymocyte globulin induction. N = 132 were excluded from the study because of basiliximab induction. ATG-F was given to 90 patients (50.8%), and Thymo was given to 87 (49.2%).

Figure 2

Hemoglobin concentration and platelet count within the first month after kidney transplantation. (A) Hemoglobin concentration: the hemoglobin concentrations were significantly lower at days 7, 14, and 28 in the ATG-F group, as compared with the Thymo group (p < 0.01 for all points). (B) Platelet count: the platelet count was significantly lower in the ATG-F group at day 7 (193 ± 64 G/L in the Thymo group vs. 164 ± 58 G/L in the ATG-F group; p = 0.003) but similar at days 14 and 28 (p = 0.54 and p = 0.27, respectively) in both groups.