Introduction:
The present is a prospective study evaluating the use of absolute lymphocyte count in determining ATLG induction dose in kidney transplant recipients (KTR).
Methods:
The present is a prospective observational study conducted in the kidney transplant department of a tertiary care center over 12 months. As per protocol, 27 kidney transplant recipients of the intermediate-risk group were given dynamic anti-T lymphocyte globulin (ATLG)-Grafalon dosing as an induction agent along with standard triple immunosuppressive therapy. Patients with high and low immunological risk were excluded. As per dynamic Grafalon dosing, the KTR received the first dose (3 mg/kg) on the day of the kidney transplant. Subsequent doses were determined according to absolute lymphocyte count. The mean absolute lymphocyte count of 500 was kept as a a cutoff to determine the dose. The patients were followed up for infections and incidences of acute rejection for 3 months. A comparison of graft outcome, rejections, and infections between 27 KTR receiving dynamic Grafalon dosing was done with historical data of 27 KTR who received standard Grafalon dosing (8 mg/kg).
Results:
In the study,27 kidney transplant recipients received Grafalon dosing according to absolute lymphocyte count.The KTP receiving dynamic Grafalon dosing had mean age of 43+-15.37 years with male to female ratio of 3.5.The mean Grafalon dosage was 6.26+-0.72 mg/kg.The incidence of infection at 7 days,1 month and 3 months follow up were 4(14.82%),4(14.82%) and 0(0%),whereas the incidence of acute rejection were 1(3.7%), 2(7.41%) and 0(0%).The historical data of 27 kidney transplant recipients receiving Grafalon dosage of 8 mg/kg had mean age of 43.67+-14.5 years with male to female ratio of 2.85.The incidence of infection at 7 days,1 month and 3 months was found to be 6(22.22%),3(11.11% )and 0(0%)whereas the incidence of acute rejection was 3(11.22%),2(7.41%) and 2(7.41%).The KTR in both the groups had urinary tract infections on follow up with no reporting of lower respiratory tract infection,surgical site infection,CMV viremia or any other infection.On comparing the kidney transplant recipients receiving dynamic Grafalon dosage according to ALC count to historical data of KTP receiving standard Grafalon dosage,there was no statistical difference in the rate of infection and rejection (P value>0.1).The study further showed that KTR with dynamic induction dosage had 21.75% reduction in mean Grafalon dose with reduction in mean cost of Grafalon by 21.71% ,compared to historical KTR.
Conclusions:
The present study focuses on the use of Absolute lymphocyte count a simple bedside tool in determining the dosage of induction agent in kidney transplant recipients.Reduced dosage of induction agent decreases the risk of infections and also reduces the cost of kidney transplant. Our study has limitations in terms of sample size and short duration of followup . Further studies in larger number of patients with longer duration of followup are needed to evaluate the risk of infections as well rejections in patients the value of absolute lymphocyte count in determining the dosage of induction agent in KTR.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.