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Experimental and Clinical... Apr 2021The number of elderly kidney transplant recipients is increasing, and age-tailored induction immunosuppression regimens are needed. We compared safety and efficacy of...
OBJECTIVES
The number of elderly kidney transplant recipients is increasing, and age-tailored induction immunosuppression regimens are needed. We compared safety and efficacy of basiliximab versus thymoglobulin at various dosages.
MATERIALS AND METHODS
Of 590 kidney transplants at our center from 2012 to 2019, 119 (20.1%) were for recipients over 65 years of age; 118 patients received deceased donor kidneys, and 1 received a related living donor kidney. We retrospectively reviewed medical records for demographics, baseline characteristics, donor characteristics, induction regimens, infectious complications, graft function, and patient survival.
RESULTS
Patients were subdivided into the following 4 induction immunosuppression groups: basiliximab (n = 15, 12.6%), 3 mg/kg thymoglobulin (n = 8, 6.7%), 4.5 mg/kg thymoglobulin (n = 67, 56.3%), and 6 mg/kg thymoglobulin (n = 29, 24.4%). All patients received pulse doses of methylprednisolone followed by a prednisone taper. Other maintenance immunosuppression agents included tacrolimus and mycophenolic acid. Recipients in the basiliximab and 3 mg/kg thymoglobulin groups were older (median age ⟩70 years; P ⟨ .001). The 4.5 and 6 mg/kg thymoglobulin groups had higher proportions of African American patients and patients with calculated panel reactive antibody over 20%. There were significantly fewer infectious complications in the basiliximab and 3 mg/kg thymoglobulin groups. Despite differences in biopsy-proven acute rejection rates, estimated glomerular filtration rate and graft and patient survival rates at 1 year were similar across groups. All patients with biopsy-proven acute rejection were African American patients.
CONCLUSIONS
Kidney transplant in patients ≥65 years is safe and feasible. Changes in this unique population's immune system warrant age-tailored regimens. We found that patients at low immunologic risk would benefit from basiliximab orthymoglobulin at 3 mg/kg. Regardless of calculated panel reactive antibodies, African American patients should be considered as high immunologic risk group forrejection, and higher thymoglobulin dosing should be considered.
Topics: Aged; Aged, 80 and over; Antilymphocyte Serum; Basiliximab; Humans; Immunosuppression Therapy; Kidney Transplantation; Retrospective Studies; Treatment Outcome
PubMed: 33834956
DOI: 10.6002/ect.2020.0434 -
Journal of the American Society of... Nov 2019
Topics: Antilymphocyte Serum; Histocompatibility Testing; Humans; Kidney Transplantation; Kinetics; Waiting Lists
PubMed: 31653785
DOI: 10.1681/ASN.2019090946 -
The Journal of Investigative Dermatology Jul 1985Twelve patients with bone marrow failure, who were undergoing therapy with daily intravenous infusions of horse antithymocyte globulin, were studied for the development...
Twelve patients with bone marrow failure, who were undergoing therapy with daily intravenous infusions of horse antithymocyte globulin, were studied for the development of serum sickness. Eleven of 12 patients developed typical signs and symptoms of serum sickness 8-13 days after the initiation of treatment. These included fever, malaise, cutaneous eruptions, arthralgias, gastrointestinal disturbances, and lymphadenopathy. Eleven of 12 patients developed high levels of circulating immune complexes during serum sickness. All 12 patients also had concomitant decreases of serum C3 and C4 levels. In addition to urticarial and/or morbilliform eruptions, 8 of 11 patients also developed a serpiginous band of erythema along the sides of the fingers, hands, toes, or feet as an early cutaneous sign of serum sickness. Direct immunofluorescence of lesional skin biopsies during serum sickness revealed deposits of immunoglobulin or complement in the walls of small cutaneous blood vessels in 3 of 5 patients. These findings indicate that circulating immune complexes play a central role in the pathophysiology of human sickness.
Topics: Animals; Antigen-Antibody Complex; Antilymphocyte Serum; Complement System Proteins; Fluorescent Antibody Technique; Horses; Humans; Prospective Studies; Serum Sickness; Skin; Thymus Gland
PubMed: 3891879
DOI: 10.1111/1523-1747.ep12275641 -
Journal of the American Society of... Nov 2016
Topics: Antilymphocyte Serum; CD4-Positive T-Lymphocytes; Graft Rejection; Immunosuppressive Agents; Kidney Transplantation
PubMed: 27225038
DOI: 10.1681/ASN.2016040470 -
Transplant International : Official... Aug 2006Post-transplant de novo malignancies are reviewed in three time periods: (i) the azathioprine (AZA) era from 1962 to 1980-1981, (ii) the cyclosporine (CYA) era (1980 to... (Review)
Review
Post-transplant de novo malignancies are reviewed in three time periods: (i) the azathioprine (AZA) era from 1962 to 1980-1981, (ii) the cyclosporine (CYA) era (1980 to present) in which the calcineurin inhibitors, CYA and tacrolimus (TAC), were the mainstay of recipient immunosuppression, and (iii) the TOR inhibitor era starting in the year 2000. Both transplant registry and transplant center reports on malignancies occurring in the AZA era are reviewed. Reports from transplant centers and from the Cincinnati Transplant Tumor Registry (CTTR) in both the early CYA era (1980s) and the 1900-2000 CYA era are reported. Cancer incidence associated with AZA versus CYA, CYA versus TAC, and AZA versus mycophenolate mofetil (MMF) is compared in both transplant center and registry reports including new, unreported Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) data from 1998 to 2003. The malignancy incidence associated with lymphocyte-depleting antibody and corticosteroid immunosuppression is discussed. Reduced malignancy incidence recently reported with TOR inhibitors is compared with that of conventional immunosuppression. Important nondrug factors influencing the incidence of post-transplant malignancies from seven single and three registry reports are detailed. The substantial role that de novo malignancies play in post-transplant mortality is discussed. Finally, management recommendations for recipients who develop de novo post-transplant malignancies are briefly presented.
Topics: Antilymphocyte Serum; Azathioprine; Cyclosporine; Europe; Female; History, 20th Century; History, 21st Century; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Neoplasms; Ohio; Registries; Sirolimus; Tacrolimus; United States
PubMed: 16827677
DOI: 10.1111/j.1432-2277.2006.00330.x -
American Journal of Transplantation :... Mar 2019
Topics: Antilymphocyte Serum; Graft Rejection
PubMed: 30203616
DOI: 10.1111/ajt.15114 -
Clinical and Experimental Immunology Sep 1969
Review
Topics: Animal Diseases; Animals; Antibody Formation; Antigen-Antibody Reactions; Antilymphocyte Serum; Antineoplastic Agents; Arthritis; Autoimmune Diseases; Child; Child, Preschool; Complement System Proteins; Dogs; Drug Synergism; Encephalomyelitis, Autoimmune, Experimental; Guinea Pigs; Haplorhini; Humans; Immune Sera; Immunity; Inflammation; Lupus Erythematosus, Systemic; Lymph Nodes; Lymphocytes; Mice; Rats; Spleen; Thymus Gland; Transplantation Immunology; Virus Diseases
PubMed: 4980325
DOI: No ID Found -
Drugs Sep 2014In the 30 years since the rabbit antithymocyte globulin (rATG) Thymoglobulin(®) was first licensed, its use in solid organ transplantation and hematology has expanded... (Review)
Review
In the 30 years since the rabbit antithymocyte globulin (rATG) Thymoglobulin(®) was first licensed, its use in solid organ transplantation and hematology has expanded progressively. Although the evidence base is incomplete, specific roles for rATG in organ transplant recipients using contemporary dosing strategies are now relatively well-identified. The addition of rATG induction to a standard triple or dual regimen reduces acute cellular rejection, and possibly humoral rejection. It is an appropriate first choice in patients with moderate or high immunological risk, and may be used in low-risk patients receiving a calcineurin inhibitor (CNI)-sparing regimen from time of transplant, or if early steroid withdrawal is planned. Kidney transplant patients at risk of delayed graft function may also benefit from the use of rATG to facilitate delayed CNI introduction. In hematopoietic stem cell transplantation, rATG has become an important component of conventional myeloablative conditioning regimens, following demonstration of reduced acute and chronic graft-versus-host disease. More recently, a role for rATG has also been established in reduced-intensity conditioning regimens. In autoimmunity, rATG contributes to the treatment of severe aplastic anemia, and has been incorporated in autograft projects for the management of conditions such as multiple sclerosis, Crohn's disease, and systemic sclerosis. Finally, research is underway for the induction of tolerance exploiting the ability of rATG to induce immunosuppresive cells such as regulatory T-cells. Despite its long history, rATG remains a key component of the immunosuppressive armamentarium, and its complex immunological properties indicate that its use will expand to a wider range of disease conditions in the future.
Topics: Antilymphocyte Serum; Autoimmunity; Immunosuppressive Agents; Stem Cell Transplantation; Transplants
PubMed: 25164240
DOI: 10.1007/s40265-014-0277-6 -
Haematologica Mar 2009The combination of antithymocyte globulin of horse origin and cyclosporine A is the standard treatment for aplastic anemia in patients not eligible for bone marrow...
The combination of antithymocyte globulin of horse origin and cyclosporine A is the standard treatment for aplastic anemia in patients not eligible for bone marrow transplantation. In this perspective article, Drs. Passweg and Tichelli discuss the current immunosuppressive therapy of aplastic anemia. See related article on page 348.
Topics: Anemia, Aplastic; Antilymphocyte Serum; Cyclosporine; Drug Therapy, Combination; Humans; Immunosuppressive Agents; Recurrence; Sirolimus; Treatment Outcome
PubMed: 19252172
DOI: 10.3324/haematol.2008.002329 -
American Journal of Transplantation :... Mar 2014
Topics: Animals; Antilymphocyte Serum; Humans; T-Lymphocytes
PubMed: 24447779
DOI: 10.1111/ajt.12622