AUTHOR=Masset Christophe , Kerleau Clarisse , Blancho Gilles , Hourmant Maryvonne , Walencik Alexandre , Ville Simon , Kervella Delphine , Cantarovich Diego , Houzet Aurélie , Giral Magali , Garandeau Claire , Dantal Jacques ,  the Nantes DIVAT Consortium , Blancho Gilles , Branchereau Julien , Cantarovich Diego , Cesbron Anne , Chapelet Agnès , Dantal Jacques , Delbos Florent , Deltombe Clément , Devis Anne , Figueres Lucile , Gaisne Raphael , Garandeau Claire , Giral Magali , Gourraud-Vercel Caroline , Hourmant Maryvonne , Kandel-Aznar Christine , Karam Georges , Kerleau Clarisse , Kervella Delphine , Leclech Alice , Leman Claire , Masset Christophe , Meurette Aurélie , Renaudin Karine , Ville Simon , Walencik Alexandre 

TITLE=Very Low Dose Anti-Thymocyte Globulins Versus Basiliximab in Non-Immunized Kidney Transplant Recipients

JOURNAL=Transplant International

VOLUME=Volume 36 - 2023

YEAR=2023

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2023.10816

DOI=10.3389/ti.2023.10816

ISSN=1432-2277

ABSTRACT=Background. The choice between Basiliximab (BSX) or Anti-Thymocyte Globulin (ATG) as induction therapy in non-immunized kidney transplant recipients remains uncertain. Whilst ATG may allow steroid withdrawal and a decrease in tacrolimus, it also increases the risk of viral reactivations due to a prolonged dose-dependent lymphopenia. We investigated outcomes in non-immunized patients receiving a very low dosage of ATG versus BSX as induction therapy. 

Methods. In this monocentric study, we analysed non-immunized patients receiving a first kidney transplant between 2015 and 2020. The study outcomes were patient and graft survival, cumulative probabilities of biopsy proven acute rejection (BPAR), infectious episode, CMV infection, post-transplantation malignancy and post-transplant diabetes (PTD). Cox, logistic or linear statistical models were used depending on the studied outcome and models were weighted on propensity scores. 

Results. 183 patients were included: 100 receiving ATG (mean total dose of 2.0 mg/kg) and 83 receiving BSX. Maintenance therapy was comparable between the groups. Patient and graft survival did not differ between groups, nor did malignancies, infectious complications or CMV viremia. There was a trend for a higher occurrence of a first BPAR in the BSX group (HR at 1.92; 95% CI: 0.77; 4.78, p-value = 0.15) with a significantly higher BPAR episodes (17% vs 7.3%, p = 0.0152). PTD occurrence was significantly higher in the BSX group (HR at 2.44; 95% CI: 1.09; 5.46; p-value = 0.03). 

Conclusion. Induction with a very low dose of ATG in non-immunized recipients was safe and associated with a comparable occurrence of BPAR but lower PTD without increasing infectious complications.