Korean J Transplant.  2023 Nov;37(Suppl 1):S86. 10.4285/ATW2023.F-6681.

A study of the effectiveness of anti-T-lymphocyte globulin as an induction drug in kidney transplantation

• Sarkar P
• Datta J

• KMID: 2551673
• DOI: http://doi.org/10.4285/ATW2023.F-6681

Abstract

Background
Polyclonal antibodies, such as antithymocyte globulin (ATG) and anti-T-lymphocyte globulin (ATLG), are often used in solid organ transplant patients. The role and dose of ATLG in Indian patients need to be standardized. This study will report on our clinical experience using ATLG in patients receiving kidney transplants.
Methods
We analyzed the medical records of 110 patients who received ATLG as an induction agent for a kidney transplant from May 2019 to May 2022 for this retrospective, single-center study. Patients received the typical triple immunosuppressive regimen of tacrolimus, mycophenolate mofetil, and methylprednisolone.
Results
A total of 110 patients were given pretransplant ATLG at a mean dosage of 6 mg/kg. There were 77 men (70%) among the 110 patients. The mean age of the patients was 45.03±13.94 years. Patients survived with ATLG (n=106, 96.37%), however,four patients deceased posttransplant, one from acute liver failure, one from antibody-mediated rejection (ABMR), and two with coronavirus disease 2019 (COVID-19) pneumonia. Posttransplant kidney function is preserved, and serum creatinine lev-els were within acceptable ranges. The majority of the prevalent causes for readmission were urinary tract infection (E. Coli; n=8), leucopenia (n=2), acute liver damage (n=1), acute tubular necrosis (n=1), and azotemia (n=1). Posttransplant pneumonia occurred in seven patients, five of whom were caused by Klebsiella and two with COVID-19. Overall, 10 instances of rejection followed by transplant occurred, with six related to cell-mediated and four due to ABMR. ATLG displayed statistically significant immunosuppression in absolute lymphocyte count, absolute CD3, absolute CD4, absolute CD8, and CD4/CD8 ratio as an induc-tion agent (P<0.0001).
Conclusions
In kidney transplant recipients, the use of ATLG as an induction agent offers sufficient immunosuppression with a high overall survival rate. A proactive strategy is required for urinary tract infection prevention.