Korean J Transplant.  2022 Nov;36(Supple 1):S23. 10.4285/ATW2022.F-1180.

Optimal dose of anti-thymocyte globulin to improve allograft and patient survival after kidney transplantation: analysis from Korean Organ Transplantation Registry data

Affiliations
  • 1Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Abstract

Background
The optimal dose of anti-thymocyte globulin (ATG) as an induction regimen in Asian kidney recipients is unclear.
Methods
We performed a retrospective cohort study of 4,579 adult patients who received renal transplantation in South Korea between January, 2015 and December, 2019. Patients who received ATG induction were divided into two groups according to the dose of ATG. For creating high-quality propensity score weights, The Toolkit for Weighting and Analysis of Nonequivalent Groups (TWANG) package was applied.
Results
Of the 924 recipients with ATG induction, 467 were classified as low dose ATG group and 457 as high dose ATG group based on median value of ATG dose, 4.5 mg/kg. During the 4-year follow-up, the rate of biopsy-proven acute rejection was significantly higher in the high dose group compared with other groups (high dose ATG 25.6%, low dose ATG 22.4%, and basilix-imab 20.8%; P<0.0001). However, overall graft failure was significantly lower in the high dose ATG group (high dose ATG 2.6%, low dose ATG 5.0%, and basiliximab 4.0%; P<0.0001) whereas it is likely that death-censored graft failure was lower in the high dose ATG group with marginal significance (high dose ATG 1.7%, low dose ATG 2.2%, and basiliximab 2.4%; P=0.08). Further-more, mortality was significantly lower in the high-dose ATG group (high dose ATG 1.0%, low dose ATG 2.8%, and basiliximab 1.7%; P<0.0001).
Conclusions
Compared to basiliximab and low dose ATG induction, high dose ATG induction (more than 4.5 mg/kg) showed su-perior outcomes in terms of graft and patient survival.

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