Supplementary Material for: Low-Dose RATG with or without Basiliximab in Renal Transplantation: A Matched-Cohort Observational Study
Gentile G.
Somma C.
Gennarini A.
Mastroluca D.
Rota G.
Lacanna F.
Locatelli B.
Remuzzi G.
Ruggenenti P.
10.6084/m9.figshare.4558018.v1
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>
2017-01-17 15:22:50
Kidney transplantation
Graft rejection
Induction
Basiliximab
Thymoglobulin
Steroid withdrawal
Minimization