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The Influence of Antithymocyte Globulin Dose on the Incidence of CMV Infection in High-risk Kidney Transplant Recipients Without Pharmacological Prophylaxis.
de Paula, Mayara I; Bae, Sunjae; Shaffer, Ashton A; Garonzik-Wang, Jacqueline; Felipe, Claudia R; Cristelli, Marina P; Waldram, Madeleine M; Massie, Allan B; Medina-Pestana, Jose; Segev, Dorry L; Tedesco-Silva, Helio.
Afiliação
  • de Paula MI; Department of Nephrology, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil.
  • Bae S; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Shaffer AA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Garonzik-Wang J; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
  • Felipe CR; Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD.
  • Cristelli MP; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Waldram MM; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
  • Massie AB; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Medina-Pestana J; Department of Nephrology, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil.
  • Segev DL; Department of Nephrology, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil.
  • Tedesco-Silva H; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Transplantation ; 104(10): 2139-2147, 2020 10.
Article em En | MEDLINE | ID: mdl-31978003
BACKGROUND: Optimizing antithymocyte globulin (ATG) dosage is critical, particularly for high-risk kidney transplant (KT) recipients without cytomegalovirus (CMV) prophylaxis. METHODS: We studied 630 KT recipients with expanded criteria donors or panel reactive antibody ≥50% at Hospital do Rim, Brazil (January 1, 2013 to May 21, 2015) to determine whether a single ATG dose was safe and effective in patients without CMV prophylaxis. Patients received ≥4 doses (1-1.5 mg/kg/per dose) until June 17, 2014, when the induction protocol changed to a single ATG dose (3 mg/kg). We used Cox regression to compare the risk of CMV infection and acute rejection (AR) among KT recipients by ATG dose. RESULTS: Adjusting for clinical and transplant factors, a single ATG dose was associated with a lower risk of CMV infection (adjusted hazard ratio [aHR]: 0.63; 95% confidence interval [CI], 0.42-0.93; P = 0.02) and a similar risk of AR (aHR: 1.16; 95% CI, 0.47-2.83; P = 0.8), compared to multiple doses. We found no differences in death-censored graft loss (5.0% versus 4.8%, aHR: 1.06; 95% CI, 0.51-2.23; P = 0.9) or mortality (4.7% versus 3.4%; aHR: 1.42; 95% CI, 0.62-3.24; P = 0.4) at 1-year post-KT by ATG dose. CONCLUSIONS: In our study of high-risk KT recipients without CMV prophylaxis, a single ATG dose decreased the risk of CMV infection without increasing the risk of AR or compromising graft or patient survival.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transplante de Rim / Infecções por Citomegalovirus / Rejeição de Enxerto / Imunossupressores / Soro Antilinfocitário Tipo de estudo: Etiology_studies / Guideline / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: America do sul / Brasil Idioma: En Revista: Transplantation Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transplante de Rim / Infecções por Citomegalovirus / Rejeição de Enxerto / Imunossupressores / Soro Antilinfocitário Tipo de estudo: Etiology_studies / Guideline / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: America do sul / Brasil Idioma: En Revista: Transplantation Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos