Abstract: SA-PO509

Reassessing Thymoglobulin Induction in Kidney Transplantation (RETHINK): An Analysis of the Scientific Registry of Transplant Recipients (SRTR)

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Ashoor, Isa, LSU Health Sciences Center, New Orleans, Louisiana, United States
  • Beyl, Robbie A, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States
  • Dharnidharka, Vikas R., Washington University School of Medicine, St Louis, Missouri, United States
Background

Recent single center studies suggest lower dose Thymoglobulin (TMG) for induction in kidney transplant (KT) provides effective rejection prophylaxis comparable to higher dose TMG with less infectious morbidity. We sought to determine whether less TMG exposure is effective in a large national cohort of KT recipients.

Methods

All first time KT only recipients in SRTR on MMF and tacrolimus based immunosuppression who received TMG induction were analyzed. Recipients of expanded criteria donor kidneys or with delayed graft function were excluded. TMG exposure days were analyzed. Primary outcome was graft failure due to acute rejection or infection by 12 mo post KT. Logistic regression was used to identify covariates affecting primary outcome.

Results

27,808 KT recipients met inclusion criteria (56% male, 52% Whites, 39% Living donor source). Most were adults (92% >21 years old) and transplanted in past 10 years since 2007 (70%). Recipients received a median of 4 days of TMG with 45% receiving 3 days or less. Low (≤3 days) and high (>3 days) TMG exposures differed in gender, transplant year, peak PRA, and HLA mismatch (Table).
The primary outcome of graft failure due to acute rejection or infection within 12 mo post KT was seen in 197 recipients. Logistic regression identified worst odds of graft failure in relation to non-white race (OR 2.2), younger age ≤21 years (OR 3.7), and older transplant era prior to 2007 (OR 2) all with p-value <0.0001. Low TMG exposure was not detrimental to graft outcome and just missed significance for benefit (OR 0.76, p-value 0.06).

Conclusion

In this large cohort of first time KT recipients on contemporary immunosuppression with TMG induction, graft failure due to acute rejection or infection within 1 year was rare, and not influenced by TMG exposure days. Further studies are needed to confirm results using granular dosage information.

Comparison of Low and High Thymoglobulin Exposure Groups
Baseline Characteristic
N = 27,808
Sub-categoryLow Thymoglobulin Exposure (≤ 3 days)
n (column %)
High Thymoglobulin Exposure (> 3 days)
n, (column %)
P-value
GenderMale
Female
7181 (58%)
5216 (42%)
8470 (55%)
6941 (45%)
< 0.0001
RaceWhite
Non-White
6414 (52%)
5983 (48%)
8054 (52%)
7357 (48%)
0.385
Age≦ 21 years old
> 21 years old
972 (8%)
11425 (92%)
1296 (8%)
14115 (92%)
0.0849
Donor TypeLiving Donor
Deceased Donor
4720 (38%)
7677 (62%)
5928 (38%)
9483 (62%)
0.5
Peak PRA<20
20-80
>80
9309 (75%)
2215 (18%)
873 (7%)
10691 (69%)
3081 (20%)
1639 (11%)
< 0.0001
HLA Mismatch (MM)0-2
3-4
5-6
2360 (19%)
5010 (40%)
5027 (41%)
3071 (20%)
6336 (41%)
6004 (39%)
0.0183
Transplant eraBefore Jan 1st, 2007
On or after Jan 1st, 2007
3093 (25%)
9304 (75%)
5221 (34%)
10190 (66%)
<0.0001

Funding

  • Other NIH Support