Low-Dose Antithymocyte Globulin Has No Disadvantages to Standard Higher Dose in Pediatric Kidney Transplant Recipients: Report from the Pediatric Nephrology Research Consortium

Authors

Isa F. Ashoor, LSU Health New Orleans
Robbie A. Beyl, Pennington Biomedical Research Center
Charu Gupta, Children’s National Hospital
Amrish Jain, Wayne State University
Stefan G. Kiessling, University of KentuckyFollow
Asha Moudgil, Children’s National Hospital
Hiren P. Patel, Nationwide Children’s Hospital
Joseph Sherbotie, University of Utah
Donald J. Weaver Jr., Atrium Health Levine Children’s
Rima S. Zahr, University of Tennessee
Vikas R. Dharnidharka, Washington University and St. Louis Children’s Hospital

Abstract

Introduction
Rabbit antithymocyte globulin (rATG) dosing strategies for induction in pediatric kidney transplantation vary between centers. It is not known whether a lower rATG induction dose provides safe and effective immunosuppression compared with a “standard” higher dose.

Methods
We performed a retrospective multicenter study of all isolated first-time kidney transplant recipients < 21 years old who received rATG induction between 1 January 2010 and 31 December 2014 at 9 pediatric centers. An a priori cutoff of a 4.5-mg/kg cumulative rATG dose was used to identify low (≤ 4.5 mg/kg) and standard (> 4.5 mg/kg) exposure groups. Outcomes examined included 12 months posttransplant graft function (estimated glomerular filtration rate [eGFR]); the occurrence of acute rejection, donor-specific antibody (DSA), neutropenia, and viral infection (cytomegalovirus [CMV], Epstein-Barr virus [EBV], and BK virus); and 24-month outcomes of posttransplant lymphoproliferative disorder (PTLD) occurrence and patient and graft survival.

Results
Two hundred thirty-five patients were included. Baseline features of the low and standard rATG dose groups were similar. By 12 months, the rATG dose group had no significant impact on the occurrence of neutropenia, positive DSA, or viral polymerase chain reaction (PCR). Graft function was similar. Acute rejection rates were similar at 17% (low dose) versus 19% (standard dose) (P = 0.13). By 24 months, graft survival (96.4% vs. 94.6%) and patient survival (100% vs. 99.3%) were similar between the low- and standard-dose groups (P = 0.54 and 0.46), whereas the occurrence of PTLD trended higher in the standard-dose group (0% vs. 2.6%, P = 0.07).

Conclusion
A low rATG induction dose ≤ 4.5 mg/kg provided safe and effective outcomes in this multicenter low immunologic risk pediatric cohort. Prospective studies are warranted to define the optimal rATG induction dose in pediatric kidney transplantation.

Document Type

Article

Publication Date

1-17-2021

Notes/Citation Information

Published in Kidney International Reports, v. 6, issue 4.

© 2021 International Society of Nephrology

This is an open access article under the CC BYNC- ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Digital Object Identifier (DOI)

https://doi.org/10.1016/j.ekir.2021.01.007

Funding Information

This study was supported in part by U54 GM104940 from the National Institute of General Medical Sciences of the National Institutes of Health which funds the Louisiana Clinical and Translational Science Center. VRD is supported in part by NIH grant R01DK102981.

Repository Citation

Ashoor, Isa F.; Beyl, Robbie A.; Gupta, Charu; Jain, Amrish; Kiessling, Stefan G.; Moudgil, Asha; Patel, Hiren P.; Sherbotie, Joseph; Weaver, Donald J. Jr.; Zahr, Rima S.; and Dharnidharka, Vikas R., "Low-Dose Antithymocyte Globulin Has No Disadvantages to Standard Higher Dose in Pediatric Kidney Transplant Recipients: Report from the Pediatric Nephrology Research Consortium" (2021). Pediatrics Faculty Publications. 315.
https://uknowledge.uky.edu/pediatrics_facpub/315