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
Summary 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 p...
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| Veröffentlicht in: | Transplant international 2021-02, Vol.34 (2), p.339-352 |
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| creator | Paula, Mayara Ivani Bowring, Mary Grace Shaffer, Ashton A. Garonzik‐Wang, Jacqueline Bessa, Adrieli Barros Felipe, Claudia Rosso Cristelli, Marina Pontello Massie, Allan B. Medina‐Pestana, Jose Segev, Dorry L. Tedesco‐Silva, Helio |
| description | Summary
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 0.140.190.25, P |
| doi_str_mv | 10.1111/tri.13800 |
| format | Article |
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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 0.140.190.25, P < 0.001) but no increased rate of hospital readmissions because of infections (0.680.911.21, P = 0.5). There was no association between 3 mg/kg rATG and CMV infection/disease (aHR 0.861.101.40, P = 0.5), even when the analysis was stratified according to recipient CMV serostatus positive (aHR 0.941.251.65, P = 0.1) and negative (aHR 0.280.571.16, P = 0.1). There was no association between 3 mg/kg rATG and mortality (aHR 0.511.253.08, P = 0.6), and graft loss (aHR 0.340.731.55, 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.</description><identifier>ISSN: 0934-0874</identifier><identifier>EISSN: 1432-2277</identifier><identifier>DOI: 10.1111/tri.13800</identifier><identifier>PMID: 33314321</identifier><language>eng</language><publisher>Switzerland: Blackwell Publishing Ltd</publisher><subject>acute rejection ; Antilymphocyte Serum ; CMV infection ; Cytomegalovirus ; Cytomegalovirus Infections - epidemiology ; Globulins ; Graft rejection ; Graft Rejection - prevention & control ; Grafting ; Health risks ; Humans ; Immunosuppressive Agents ; Incidence ; Induction therapy ; Infections ; Kidney transplantation ; Kidney Transplantation - adverse effects ; Kidney transplants ; Kidneys ; low immunological risk ; Prophylaxis ; Regression analysis ; Rejection ; Retrospective Studies ; Risk ; thymoglobulin ; Transplant Recipients</subject><ispartof>Transplant international, 2021-02, Vol.34 (2), p.339-352</ispartof><rights>2020 Steunstichting ESOT. Published by John Wiley & Sons Ltd</rights><rights>2020 Steunstichting ESOT. Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2021 Steunstichting ESOT. Published by John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4430-d213bf4faef60ce4cae1fff39ec767adfdd7fff50c13e9b8370a2149ada2bbf3</citedby><cites>FETCH-LOGICAL-c4430-d213bf4faef60ce4cae1fff39ec767adfdd7fff50c13e9b8370a2149ada2bbf3</cites><orcidid>0000-0002-9896-323X ; 0000-0002-2813-0400</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Ftri.13800$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Ftri.13800$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33314321$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Paula, Mayara Ivani</creatorcontrib><creatorcontrib>Bowring, Mary Grace</creatorcontrib><creatorcontrib>Shaffer, Ashton A.</creatorcontrib><creatorcontrib>Garonzik‐Wang, Jacqueline</creatorcontrib><creatorcontrib>Bessa, Adrieli Barros</creatorcontrib><creatorcontrib>Felipe, Claudia Rosso</creatorcontrib><creatorcontrib>Cristelli, Marina Pontello</creatorcontrib><creatorcontrib>Massie, Allan B.</creatorcontrib><creatorcontrib>Medina‐Pestana, Jose</creatorcontrib><creatorcontrib>Segev, Dorry L.</creatorcontrib><creatorcontrib>Tedesco‐Silva, Helio</creatorcontrib><title>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</title><title>Transplant international</title><addtitle>Transpl Int</addtitle><description>Summary
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 0.140.190.25, P < 0.001) but no increased rate of hospital readmissions because of infections (0.680.911.21, P = 0.5). There was no association between 3 mg/kg rATG and CMV infection/disease (aHR 0.861.101.40, P = 0.5), even when the analysis was stratified according to recipient CMV serostatus positive (aHR 0.941.251.65, P = 0.1) and negative (aHR 0.280.571.16, P = 0.1). There was no association between 3 mg/kg rATG and mortality (aHR 0.511.253.08, P = 0.6), and graft loss (aHR 0.340.731.55, 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.</description><subject>acute rejection</subject><subject>Antilymphocyte Serum</subject><subject>CMV infection</subject><subject>Cytomegalovirus</subject><subject>Cytomegalovirus Infections - epidemiology</subject><subject>Globulins</subject><subject>Graft rejection</subject><subject>Graft Rejection - prevention & control</subject><subject>Grafting</subject><subject>Health risks</subject><subject>Humans</subject><subject>Immunosuppressive Agents</subject><subject>Incidence</subject><subject>Induction therapy</subject><subject>Infections</subject><subject>Kidney transplantation</subject><subject>Kidney Transplantation - adverse effects</subject><subject>Kidney transplants</subject><subject>Kidneys</subject><subject>low immunological risk</subject><subject>Prophylaxis</subject><subject>Regression analysis</subject><subject>Rejection</subject><subject>Retrospective Studies</subject><subject>Risk</subject><subject>thymoglobulin</subject><subject>Transplant Recipients</subject><issn>0934-0874</issn><issn>1432-2277</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kstu1DAUhiMEokNhwQsgS2zaRVo7zkySDRIabpWKkNCIreU4x5MzZOxgO1Oy6yMg8Ybd8hI4zFAuAm9sy58__7ZPkjxm9IzFdh4cnjFeUnonmbGcZ2mWFcXdZEYrnqe0LPKj5IH3G0ppVs7p_eSIcz5xbJZ8ewHKgfTQEDQKGzAKiNVEqiEAcbABFdAacoWhtUOYoH_hagx2C2vZ2R26wZOT5dsPpxHRh-1oyEdsDIwkOGl830kTol1hj2CCn4aAOzRr4mRdYyBxHW-uv4R23NooB7LubD10-CtJPIH0zvbt2MnP6MnN9VciibKtdYH4qOogClTUgyM-DM34MLmnZefh0aE_TlavXq6Wb9LLd68vls8vU5XnnKZNxnitcy1BL6iCXElgWmtegSoWhWx00xRxPqeKcajqkhdUZiyvZCOzutb8OHm21_ZDvYVmSuBkJ3qHW-lGYSWKP1cMtmJtd6KcF7xgiyg4OQic_TSAD2KLXkEXHw3s4EWWF_En5xmd0Kd_oRs7OBNvF6myYrxiCxqp0z2lnPXegb4Nw6iYKkjEChI_KiiyT35Pf0v-LJkInO-BK-xg_L9JrN5f7JXfAfYN3M0</recordid><startdate>202102</startdate><enddate>202102</enddate><creator>Paula, Mayara Ivani</creator><creator>Bowring, Mary Grace</creator><creator>Shaffer, Ashton A.</creator><creator>Garonzik‐Wang, Jacqueline</creator><creator>Bessa, Adrieli Barros</creator><creator>Felipe, Claudia Rosso</creator><creator>Cristelli, Marina Pontello</creator><creator>Massie, Allan B.</creator><creator>Medina‐Pestana, Jose</creator><creator>Segev, Dorry L.</creator><creator>Tedesco‐Silva, Helio</creator><general>Blackwell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7T5</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-9896-323X</orcidid><orcidid>https://orcid.org/0000-0002-2813-0400</orcidid></search><sort><creationdate>202102</creationdate><title>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</title><author>Paula, Mayara Ivani ; Bowring, Mary Grace ; Shaffer, Ashton A. ; Garonzik‐Wang, Jacqueline ; Bessa, Adrieli Barros ; Felipe, Claudia Rosso ; Cristelli, Marina Pontello ; Massie, Allan B. ; Medina‐Pestana, Jose ; Segev, Dorry L. ; Tedesco‐Silva, Helio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4430-d213bf4faef60ce4cae1fff39ec767adfdd7fff50c13e9b8370a2149ada2bbf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>acute rejection</topic><topic>Antilymphocyte Serum</topic><topic>CMV infection</topic><topic>Cytomegalovirus</topic><topic>Cytomegalovirus Infections - epidemiology</topic><topic>Globulins</topic><topic>Graft rejection</topic><topic>Graft Rejection - prevention & control</topic><topic>Grafting</topic><topic>Health risks</topic><topic>Humans</topic><topic>Immunosuppressive Agents</topic><topic>Incidence</topic><topic>Induction therapy</topic><topic>Infections</topic><topic>Kidney transplantation</topic><topic>Kidney Transplantation - adverse effects</topic><topic>Kidney transplants</topic><topic>Kidneys</topic><topic>low immunological risk</topic><topic>Prophylaxis</topic><topic>Regression analysis</topic><topic>Rejection</topic><topic>Retrospective Studies</topic><topic>Risk</topic><topic>thymoglobulin</topic><topic>Transplant Recipients</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Paula, Mayara Ivani</creatorcontrib><creatorcontrib>Bowring, Mary Grace</creatorcontrib><creatorcontrib>Shaffer, Ashton A.</creatorcontrib><creatorcontrib>Garonzik‐Wang, Jacqueline</creatorcontrib><creatorcontrib>Bessa, Adrieli Barros</creatorcontrib><creatorcontrib>Felipe, Claudia Rosso</creatorcontrib><creatorcontrib>Cristelli, Marina Pontello</creatorcontrib><creatorcontrib>Massie, Allan B.</creatorcontrib><creatorcontrib>Medina‐Pestana, Jose</creatorcontrib><creatorcontrib>Segev, Dorry L.</creatorcontrib><creatorcontrib>Tedesco‐Silva, Helio</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Transplant international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Paula, Mayara Ivani</au><au>Bowring, Mary Grace</au><au>Shaffer, Ashton A.</au><au>Garonzik‐Wang, Jacqueline</au><au>Bessa, Adrieli Barros</au><au>Felipe, Claudia Rosso</au><au>Cristelli, Marina Pontello</au><au>Massie, Allan B.</au><au>Medina‐Pestana, Jose</au><au>Segev, Dorry L.</au><au>Tedesco‐Silva, Helio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Transplant international</jtitle><addtitle>Transpl Int</addtitle><date>2021-02</date><risdate>2021</risdate><volume>34</volume><issue>2</issue><spage>339</spage><epage>352</epage><pages>339-352</pages><issn>0934-0874</issn><eissn>1432-2277</eissn><abstract>Summary
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 0.140.190.25, P < 0.001) but no increased rate of hospital readmissions because of infections (0.680.911.21, P = 0.5). There was no association between 3 mg/kg rATG and CMV infection/disease (aHR 0.861.101.40, P = 0.5), even when the analysis was stratified according to recipient CMV serostatus positive (aHR 0.941.251.65, P = 0.1) and negative (aHR 0.280.571.16, P = 0.1). There was no association between 3 mg/kg rATG and mortality (aHR 0.511.253.08, P = 0.6), and graft loss (aHR 0.340.731.55, 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.</abstract><cop>Switzerland</cop><pub>Blackwell Publishing Ltd</pub><pmid>33314321</pmid><doi>10.1111/tri.13800</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0002-9896-323X</orcidid><orcidid>https://orcid.org/0000-0002-2813-0400</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | acute rejection Antilymphocyte Serum CMV infection Cytomegalovirus Cytomegalovirus Infections - epidemiology Globulins Graft rejection Graft Rejection - prevention & control Grafting Health risks Humans Immunosuppressive Agents Incidence Induction therapy Infections Kidney transplantation Kidney Transplantation - adverse effects Kidney transplants Kidneys low immunological risk Prophylaxis Regression analysis Rejection Retrospective Studies Risk thymoglobulin Transplant Recipients |
| title | 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 |
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