10.6084/m9.figshare.4558018.v1
Gentile G.
Gentile
G.
Somma C.
Somma
C.
Gennarini A.
Gennarini
A.
Mastroluca D.
Mastroluca
D.
Rota G.
Rota
G.
Lacanna F.
Lacanna
F.
Locatelli B.
Locatelli
B.
Remuzzi G.
Remuzzi
G.
Ruggenenti P.
Ruggenenti
P.
Supplementary Material for: Low-Dose RATG with or without Basiliximab in Renal Transplantation: A Matched-Cohort Observational Study
Karger Publishers
2017
Kidney transplantation
Graft rejection
Induction
Basiliximab
Thymoglobulin
Steroid withdrawal
Minimization
2017-01-17 15:22:50
Dataset
https://karger.figshare.com/articles/dataset/Supplementary_Material_for_Low-Dose_RATG_with_or_without_Basiliximab_in_Renal_Transplantation_A_Matched-Cohort_Observational_Study/4558018
<p><b><i>Background/Aims:</i></b> In renal transplantation,
peri-operative low-dose rabbit-antithymocyte-globulin (RATG) plus
basiliximab induction prevented acute allograft rejection more
effectively than post-operative RATG plus basiliximab induction. We
investigated the specific antirejection contribution of basiliximab in
this context. <b><i>Methods:</i></b> This single-center, observational,
matched-cohort study evaluated allograft rejections (primary outcome),
steroid exposure and side effects, GFR (iohexol plasma clearance) and
treatment costs in 16 deceased-donor renal transplant recipients induced
with RATG (0.5 mg/kg/day) and 32 age-, gender- and treatment-matched
reference-patients given RATG plus basiliximab (20 mg on days 0 and 4). <b><i>Results:</i></b>
Induction was well tolerated. At 18 months, 8 patients (50%) vs. 3
reference-patients (9.4%) rejected the graft [HR (95% CI): 6.53
(1.73-24.70), p = 0.006]. Difference was significant (p < 0.01) even
after adjusting for recipient/donor age and gender, cold ischemia time
and HLA mismatches. There were 1 antibody-mediated rejection and 2
moderate cellular rejections in patients vs. none in reference-patients
(p = 0.032). The median (interquartile range) prednisone cumulative dose
was remarkably higher in patients than reference-patients [4.78
(1.12-6.10) vs. 0.19 (0.18-3.81) grams, p = 0.002]. Three patients vs.
24 reference-patients were off-steroid at study end (p < 0.001).
Three patients vs. no reference-patient developed new-onset diabetes (p =
0.003). Both inductions similarly depleted B-cells. Outcomes of AZA-
vs. MMF-treated participants were similar. GFR was similar in all
groups. Compared to MMF, AZA therapy saved ≈ EUR 2,500/year and by month
14.3 post-transplant compensated basiliximab costs. <b><i>Conclusion:</i></b>
In renal transplantation, basiliximab plus peri-operative low-dose RATG
more efficiently prevented allograft rejection than RATG monotherapy,
and minimized steroid exposure and toxicity. AZA- vs MMF-based
maintenance immunosuppression largely compensated the extra costs of
basiliximab.</p>