The Influence of Antithymocyte Globulin Dose on the Incidence of CMV Infection in High-risk Kidney Transplant Recipients Without Pharmacological Prophylaxis

• Published in: Transplantation Vol. 104; no. 10; p. 2139
• Main Authors: de Paula, Mayara I, Bae, Sunjae, Shaffer, Ashton A, Garonzik-Wang, Jacqueline, Felipe, Claudia R, Cristelli, Marina P, Waldram, Madeleine M, Massie, Allan B, Medina-Pestana, Jose, Segev, Dorry L, Tedesco-Silva, Helio
• Format: Journal Article
• Language: English
• Published: United States 01.10.2020
• Subjects: Adult; Antilymphocyte Serum - administration & dosage; Antilymphocyte Serum - adverse effects; Brazil; Cytomegalovirus Infections - immunology; Cytomegalovirus Infections - mortality; Cytomegalovirus Infections - prevention & control; Female; Graft Rejection - immunology; Graft Rejection - mortality; Graft Rejection - prevention & control; Graft Survival; Humans; Immunocompromised Host; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Incidence; Kidney Transplantation - adverse effects; Kidney Transplantation - mortality; Male; Middle Aged; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Brazil
• ISSN: 1534-6080
• DOI: 10.1097/TP.0000000000003124

Optimizing antithymocyte globulin (ATG) dosage is critical, particularly for high-risk kidney transplant (KT) recipients without cytomegalovirus (CMV) prophylaxis. We studied 630 KT recipients with expanded criteria donors or panel reactive antibody ≥50% at Hospital do Rim, Brazil (January 1, 2013 to May 21, 2015) to determine whether a single ATG dose was safe and effective in patients without CMV prophylaxis. Patients received ≥4 doses (1-1.5 mg/kg/per dose) until June 17, 2014, when the induction protocol changed to a single ATG dose (3 mg/kg). We used Cox regression to compare the risk of CMV infection and acute rejection (AR) among KT recipients by ATG dose. Adjusting for clinical and transplant factors, a single ATG dose was associated with a lower risk of CMV infection (adjusted hazard ratio [aHR]: 0.63; 95% confidence interval [CI], 0.42-0.93; P = 0.02) and a similar risk of AR (aHR: 1.16; 95% CI, 0.47-2.83; P = 0.8), compared to multiple doses. We found no differences in death-censored graft loss (5.0% versus 4.8%, aHR: 1.06; 95% CI, 0.51-2.23; P = 0.9) or mortality (4.7% versus 3.4%; aHR: 1.42; 95% CI, 0.62-3.24; P = 0.4) at 1-year post-KT by ATG dose. In our study of high-risk KT recipients without CMV prophylaxis, a single ATG dose decreased the risk of CMV infection without increasing the risk of AR or compromising graft or patient survival.