Lower dose ATG Induction - effective,cheaper and safer

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Lower dose ATG Induction - effective,cheaper and safer

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Co-author 1

Navva Pavan Kumar Rao pavannavva@yahoo.com TX HOSPITAL NEPHROLOGY HYDERABAD India *

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Introduction

Induction immunosuppression aims to prevent rejection after kidney transplantation but may increase infection risk. This study evaluated infectious and rejection outcomes with two Grafalon(Rabbit ATG) dosing regimens in high-immunological-risk patients.

Methods

In a prospective observational study over 18 months, 66 Immunological high-risk kidney transplant recipients (spousal, unrelated, cadaveric) received Grafalon induction—30 patients with 3 mg/kg body weight and 26 with 1 mg/kg body weight. Infectious and rejection episodes were recorded during the first 3 months. Fisher’s exact test, odds ratios (OR), and 95% confidence intervals (CI) were used.

Results

The 3 mg/kg group had higher infection episodes per patient (1.33 vs 0.77; p=0.41) and a higher proportion of patients with infection (67%, 95% CI 50.0–83.5% vs 54%, 34.7–73.0%). Severe infections incidence was 26.7% (95% CI 10.8–42.5%) vs 7.7% (0–17.9%) (OR 4.36, 95% CI 0.83–22.81; p=0.09). Mortality was 6.7% (0–15.6%) vs 0% (OR 4.65, 95% CI 0.21–101.4; p=0.49). Rejection rates were comparable (3.3% vs 3.9%). All rejection episodes responded to treatment.The cost of the therapy also doubles or triples in higher dose regimens.

Conclusion

Higher-dose Grafalon (3 mg/kg) increases infection and mortality risk trends without improving rejection prevention compared to 1 mg/kg in high-risk kidney transplants. The lower dose may better balance immunosuppression safety and efficacy.The lower dose regimen gives an additional financial advantage too.

Kewords