Introduction:
ABO-incompatible kidney transplantation involves desensitization protocols and anti-thymoglobulin induction therapy. The combination of ABO-incompatibility and anti-HLA sensitization poses a significant immunological risk in kidney transplantation. This study evaluates the efficacy and safety of two anti-thymocyte globulins, Grafalon (r-ATLG) and Thymoglobulin (r-ATG), in kidney transplants with both ABO and HLA sensitization.
Methods:
This single-center, retrospective study, conducted between March 2021 and February 2024, included 28 ABO-incompatible kidney transplant recipients. For maintenance immunosuppression, all patients received a triple therapy regimen consisting of Tacrolimus, Mycophenolate Mofetil / Sodium, and Prednisone.
Results:
The study population included 17 patients who received Grafalon (3 mg/kg IV) and 11 patients who received Thymoglobulin (1.5 mg/kg IV) on days 0 and 2 of transplantation. Both groups showed comparable outcomes in terms of rejection rates (6% for Grafalon vs. 10% for Thymoglobulin), infection rates (12% for Grafalon vs. 19% for Thymoglobulin), and 3-year graft and patient survival (83% for Grafalon vs. 80% for Thymoglobulin). At the last follow-up, graft function, as measured by serum creatinine levels, was 1±0.37 mg/dL in the Grafalon group and 1.17±0.34 mg/dL in the Thymoglobulin group. The anti-HLA donor-specific antibody (DSA) levels decreased from a mean fluorescence intensity (MFI) of >5000 pre-transplant to <1200 by day 400 in both groups.
Conclusions:
Grafalon (r-ATLG) and Thymoglobulin (r-ATG) demonstrated equivalent safety and efficacy in the short-term management of kidney transplant recipients with both anti-HLA and high anti-ABO antibody titers (1/2048). Both agents were effective in reducing rejection and infection rates, and in preserving graft and patient survival.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.