2010 - TTS International Congress


Clinical Immunosuppression Kidney late

19.1 - Low Dose Rabbit Anti-Thymocyte Globulin in Obese Renal Transplant Patients: 8 Year Follow Up.

Presenter: Mark Reza, Laftavi, Buffalo, United States
Authors: Laftavi M., Patel S., Kohli R., Alnimri M., Said M., Feng L., Laftavi H., Pankewycz O.


LOW DOSE RABBIT ANTI-THYMOCYTE GLOBULIN IN OBESE RENAL TRANSPLANT PATIENTS: 8 YEAR FOLLOW UP.

CLINICAL IMMUNOSUPPRESSION - KIDNEY LATE

M.R. Laftavi1, S.K. Patel2, R. Kohli3, M. Alnimri2, M. Said2, L. Feng2, H. Laftavi2, O. Pankewycz2
1Surgery, SUNY at Buffalo, Buffalo/New york/UNITED STATES OF AMERICA, 2Surgery, SUNY at Buffalo, BUFFALO/UNITED STATES OF AMERICA, 3Medicine, SUNY at Buffalo, BUFFALO/UNITED STATES OF AMERICA

Body:
Introduction: Obesity is a burgeoning problem among renal transplant recipients given its association with increased morbidity, graft loss and mortality. The long-term influence of different induction therapies in obese compared to non-obese patients (pt) is uncertain. We now examine the long-term effect of low dose rabbit antithymocyte globulin 3-5 mg/kg total dose (rATG) induction therapy compared to 2 doses of 20 mg basiliximab (BSX) in non-obese and obese renal transplant recipients. Methods: The medical records of all adult (>18 yrs.) recipients of renal transplant between 6/01 and 6/09 in our center were reviewed. Pts whose BMI was >30 were considered to be obese. The average dose of rATG was 3.2±1.6 mg/kg. Results: A total of 475 pts were included. In the non-obese group with a BMI<30, 68 received BSX and 247 rATG. In the obese group 27 pts were given BSX and 133 were given rATG. Mean follow up was 1523 days. These 4 groups were similar in baseline characteristics including: donor and recipient age, percent diabetes, living donors, PRA>35, HLA MM, race, gender and maintenance immunosuppression. Serum creatinine levels at 3 mos., 1, 5 and 7 yrs. were not statistically different between groups. Viral infection rates were not statistically different between rATG and BSX groups.

Groups Pt. Survival Graft Survival** Rejection 1A Borderline Rejection Wound Infection Cancer
BSX BMI<30 86.8% 68.2% 19.1% 31.8% 0.9% 0
rATG BMI<30 91.1% 88.7%* 2.8%* 21.7%* 1.2% 2
BSX BMI>30 81.5% 63.6% 0% 18.2% 3.7% 0
rATGBMI>30 91% 90.3%* 6.8% 29% 4.4% 0

*p<0.05 vs. BSX, ** Death Censored Conclusion: In summary, low dose rATG is associated with a better long-term graft survival rates in obese pts compared to BSX induction. When rATG is used in obese and non-obese pts, there was no difference in long-term outcomes.

Disclosure: All authors have declared no conflicts of interest.


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