Abstract: SA-PO1150
Use of Antithymocyte Globulins (ATG) to Treat Rejection in Kidney Transplantation Is Associated with Increased Risk of Viral Infections and with Increased Risk of Death in Older Patients
Session Information
- Transplantation: Clinical - Rejection, Recurrent Disease, Incompatibility
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Dudreuilh, Caroline, King's College London, London, United Kingdom
- Walker-Jacobs, Abigail, King's College London, London, United Kingdom
- Ross, Linda J., Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Moutzouris, Dimitrios Anestis, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
Background
ATG is used to treat steroid-resistant T-cellular mediated rejection, vascular rejection and mixed rejection in kidney transplant recipients. Most of the studies which examined the efficacy and the safety of ATG did not include patients on modern immunosuppression regimes. In addition, they did not examine in detail the side effects of this potent treatment.
Methods
We studied the long-term efficacy and side effects of ATG in renal transplant recipients, who were treated with ATG between 2011-2018. We analysed the demographics, the types and rates of infection and cancer, the readmissions, the graft and patient survival.
Results
87 (56 males) patients were treated with ATG in the study period. The mean age was 45 ± 13.5 years. The follow-up was 50.4 ± 36 months. The ATG was effective in treating rejection in 57 patients (66%). However, 49 patients (56%) developed bacterial and viral infections after ATG use with 20 (23%) patients developing severe infections (including 3 fungal infections and 1 mycobacterium infection). 40 patients (46%) were readmitted at least once for complications related to ATG. 5 (6%) patients developed cancer and 13 patients died during the study period. The patients who died were older when treated with ATG (p=0.34). In logistic regression, death was associated with age at treatment (p=0.042) but not with the ATG dose, the gender or history of previous transplant. There was no difference between the age (p=0.58) and the dose of ATG (p=0.09) among patients who were readmitted for ATG related complications and those who did not.The total dose of ATG was associated with increased risk of viral infections (p=0.027). This remained significant in logistic regression (p=0.033)
Conclusion
ATG is an effective treatment for rejection in kidney transplantation. However, it seems that it is associated with an increased risk of viral infections. In our cohort, older patients treated with ATG were at higher risk of death. This asssociation will be investigated further.