Impact of Cumulative 6 mg/kg Antithymocyte Globulin on Early Posttransplant Outcomes in Kidney Transplant Recipients with Delayed Graft Function.
Van Anh Vu, Suverta Bhayana, Helen Sweiss and 3 others
PMID 38465633WHAT IT FOUND
Kidney transplant recipients with delayed graft function who got a protocol using 6 mg/kg antithymocyte globulin, fixed-dose mycophenolate, and early biopsy had fewer biopsy-proven acute rejections at 6 months.
The bundle also added monitoring, so the dose alone is not proven.
Key findings
01Biopsy-proven acute rejection was lower after the protocol: 10/33, 30.3% before versus 6/55, 10.9% after.
02Substantially more biopsies occurred after protocol implementation: 7/33, 21.2% before versus 51/55, 92.7% after.
03Cytopenia and infection rates were similar between groups at 6 months.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a single-center retrospective study with only 88 patients. Many post-protocol patients did not receive the intended protocol: 27 of 55 deviated, including 16 who received 4.5 mg/kg or less rabbit antithymocyte globulin. When patients who did not receive cumulative 6 mg/kg rabbit antithymocyte globulin were excluded, the rejection difference was no longer significant (10/33 versus 5/39; P = .09). The post-protocol group had far more biopsies (7/33 versus 51/55), so detection of rejection differed between groups. The pre- and post-protocol periods overlapped with the COVID-19 pandemic, which affected deaths and graft loss. Infection was defined by any positive culture, not symptoms, which may have overestimated infection rates. Outpatient medication adherence was not assessed, and follow-up was only 6 months.
Declared interests
The authors received no financial support and declared no potential conflicts of interest.
The easy way to misread this
Do not conclude that 6 mg/kg rATG alone caused the lower rejection rate. The post-protocol group also received fixed-dose mycophenolate and routine early biopsy, and many did not receive the full protocol dose.