Antithymocyte induction dosing and incidence of opportunistic viral infections using steroid‐free maintenance immunosuppression. Issue 1 (19th December 2020)

• Record Type: Journal Article
• Authors: Von Stein, Lauren; Leino, Abbie D.; Pesavento, Todd; Rajab, Amer; Winters, Holli
• Is Part Of: Clinical transplantation. Volume 35:Issue 1(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-12-19
• Subjects: Cytomegalovirus -- immunosuppressive regimens -- induction -- infection and infectious agents -- infectious -- kidney disease -- maintenance; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ctr.14102
• Languages: English
• ISSNs: 0902-0063

Abstract

Abstract: Background: Currently, there is limited literature evaluating rATG induction dosing and incidence of opportunistic viral infections when using steroid‐free maintenance immunosuppression. Methods: This single‐center, retrospective, study compared high rATG (>4.5 mg/kg) versus low (<4.5 mg/kg) induction dosing and the overall incidence of early opportunistic viral infection at 180 days in the setting of maintenance immunosuppression consisting of tacrolimus, mycophenolate, rapid steroid withdrawal, and a tiered antiviral prevention strategy based on donor‐recipient Cytomegalovirus (CMV) serostatus. Results: A total of 209 patients were included; 76 patients received low‐dose and 133 patients received high‐dose rATG. Incidence of overall opportunistic viral infection occurred more frequently in patients who received high compared to low dose (29.8% vs 25% p = .030). Incidence of CMV infection was also significantly increased in the high‐dose group (31.6% vs 18.4% p = .039). In a multivariable model, rATG dose, as a continuous variable, remained a significant independent predictor of infection along with CMV risk (OR 1.46, 95% CI 1.02‐2.09) controlling for age and CMV risk. There were no differences in graft‐related outcomes at 180 days. Conclusion: Higher cumulative rATG induction dose was associated with increased incidence of opportunistic viral infections, in the setting of a steroid‐free maintenance immunosuppression in the early post‐transplant period.