Low Total Dose of Anti-Human T-Lymphocyte Globulin (ATG) Guarantees a Good Glomerular Filtration Rate after Liver Transplant in Recipients with Pretransplant Renal Dysfunction

Cristina Dopazo, Ramón Charco, Mireia Caralt, Elizabeth Pando, José Luis Lázaro, Concepción Gómez-Gavara, Lluis Castells, Itxarone Bilbao, Cristina Dopazo, Ramón Charco, Mireia Caralt, Elizabeth Pando, José Luis Lázaro, Concepción Gómez-Gavara, Lluis Castells, Itxarone Bilbao

Abstract

We aimed to evaluate the safety and efficacy of low doses of anti-T-lymphocyte globulin (ATG)-based immunosuppression in preserving renal function and preventing liver rejection in liver transplant (LT) recipients with pretransplant renal dysfunction. We designed a prospective single-center cohort study analyzing patients with pre-LT renal dysfunction defined as eGFR<60 mL/min/1.73m2, who underwent induction therapy with ATG (ATG group, n=20). This group was compared with a similar retrospective cohort treated with basiliximab (BAS group, n=20). An economic analysis between both induction therapies was also undertaken. In the ATG group, 45% and 50% of patients had recovered their renal function without acute cellular rejection (ACR) episodes at day 7 and 1 month after LT, respectively, versus 40% and 55% of patients in the BAS group (p=1). Renal function improved in both groups over time and no differences between groups were observed regarding one-year eGRF and one-year probability of ACR. Cost per patient of the ATG course was 403€ (r: 126-756) versus 2,524€ of the basiliximab course (p=0.001). In conclusion, induction with low dose of ATG or basiliximab in patients with pretransplant renal dysfunction is a good strategy for preserving posttransplant renal function; however the use of low-dose ATG resulted in a substantial reduction in drug costs. This trail is registered with ClinicalTrials.gov number: NCT01453218.

Figures

Figure 1
Figure 1
Tacrolimus levels after liver transplantation.
Figure 2
Figure 2
Glomerular filtration rate between groups at one year.
Figure 3
Figure 3
Cumulative probability of biopsy-proven rejection after transplantation.

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Source: PubMed

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