Induction therapy: clinical and quality of life outcomes in aged renal transplant recipients.

One primary purpose of transplant is to improve quality of life (QOL) in renal transplant recipients (RTRs) ≥ 50 yr of age, where death with a functioning graft limits life years gained. We aimed to determine the impact of induction therapy, with its subsequent effects on rejection, infection, and readmissions, on QOL. Subanalysis of patients ≥ 50 yr of age that participated in a single-center, prospective, risk-stratified, randomized, open-label study. Two hundred RTRs ≥ 50 yr of age. All patients received either rabbit antithymocyte globulin (rATG) or interleukin 2 receptor antagonists (IL-2RA) in addition to tacrolimus (FK), mycophenolate mofetil (MMF), and corticosteroids in a randomized fashion. Outcome analyses included safety, efficacy, and QOL. Results reported 1 yr post-transplant. Of 111 patients ≥ 50 yr old, 48 received IL-2RA and 63 received rATG. Baseline characteristics were similar between groups. Patients that received rATG had a trend toward lower acute rejection rates, fewer readmissions, and fewer supratherapeutic tacrolimus troughs, with similar rates of infections. QOL analysis demonstrated patients that received rATG were significantly more likely to have improvements in physical and social functioning after transplant. Contrary to the common practice, T-cell depletion in recipients ≥ 50 yr of age may be beneficial.

Palanisamy AP ，Al Manasra AR ，Pilch NA ，Dowden JE ，Nadig SN ，McGillicuddy JW ，Baliga PK ，Chavin KD ，Taber DJ ... -  《-》

Prospective randomized controlled trial of rabbit antithymocyte globulin compared with IL-2 receptor antagonist induction therapy in kidney transplantation.

Pilch NA ，Taber DJ ，Moussa O ，Thomas B ，Denmark S ，Meadows HB ，McGillicuddy JW ，Srinivas TR ，Baliga PK ，Chavin KD ... -  《-》

Randomized trial of mycophenolate mofetil versus enteric-coated mycophenolate sodium in primary renal transplant recipients given tacrolimus and daclizumab/thymoglobulin: one year follow-up.

Ciancio G ，Burke GW ，Gaynor JJ ，Roth D ，Sageshima J ，Kupin W ，Tueros L ，Hanson L ，Rosen A ，Ruiz P ，Miller J ... -  《TRANSPLANTATION》

Mycophenolate mofetil suspension in pediatric renal transplantation: three-year data from the tricontinental trial.

Höcker B ，Weber LT ，Bunchman T ，Rashford M ，Tönshoff B ，Tricontinental MMF Suspension Study Group ... -  《-》

Evaluation of a Weight-based Rabbit Anti-thymocyte Globulin Induction Dosing Regimen for Kidney Transplant Recipients.

Although rabbit anti-thymocyte globulin (rATG) is commonly used as induction therapy for kidney transplantation, dosing is not standardized. Recently available findings suggest that even subtle differences in the cumulative dose of rATG induction may have an impact on acute rejection rates for patients receiving steroid-minimization maintenance immunosuppression. This investigation evaluated the potential consequences of rounding and capping rATG doses in patients receiving steroid-containing maintenance immunosuppression when calculating the dose based on actual body weight. Single-center retrospective cohort study. A large academic medical center. A total of 261 adult kidney transplant recipients between July 1, 2010, and December 31, 2012, who received rATG induction and were maintained on tacrolimus, mycophenolate, and prednisone. Incidences of biopsy-confirmed acute rejection, opportunistic infections and hematologic effects within 12 months posttransplant were assessed for patients receiving a cumulative rATG dose of 5 mg/kg or higher (5.2 ± 0.2 mg/kg, n=138) compared with those who received a cumulative rATG dose lower than  5 mg/kg (4.5 ± 0.6 mg/kg, n=123). The groups had similar baseline characteristics, immunologic risk, and indications for rATG induction. The incidence of clinically relevant biopsy-confirmed acute rejection was low and similar between the groups (8.7% for rATG of 5 mg/kg or higher vs 8.9% for rATG lower than  5 mg/kg, p=0.944). Patient survival, all-cause graft survival, and graft function did not differ between the groups. Incidences of cytomegalovirus and BK virus infection as well as the extent and duration of lymphopenia were also similar between the groups. In combination with triple maintenance immunosuppression consisting of tacrolimus, mycophenolate, and prednisone, modest differences in the cumulative rATG dose were not associated with increased risk of acute rejection. Measures to optimize rATG utilization present opportunities for cost-saving without sacrificing efficacy in this patient population.

Pennington CA ，Tischer SM ，Lee E ，Lee S ，Sindelar J Jr ，Park JM ... -  《-》