Single Reduced Dose Thymoglobuline as Induction in Kidney Retransplant

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Abstract

Introduction

Kidney retransplant is a high risk procedure, without a consensus about the best induction imunnossupression strategy. Only a few studies have evaluated these growing proportion patients outcomes, specially in Brazil. Objectives Assess the rates of CMV infection/disease, DGF, readmission in 30 days and biopssy-proven acute rejection. Assess the graft and patients survival rates after 12 months. Assess kidney function after 12 months.

Methods

Single-center, open, retrospective, exploratory cohort of kidney retransplants performed between -06/16/2014 and 09/22/2016, with 1 year follow up. All of the patients have received single dose Thymoglobuline 3mg/kg induction in the immediate postoperative day. Preemptive therapy was used against CMV. Results A total of 84 patients were included, mostly men (60,9%), with medium age 41,1 ± 11,8, 52% with PRA > 50%. Most of them (90%) received a deceased donor kidney and 15,5% met expanded criteria, with cold ischaemia time of 24,4±6,7 hours. DGF was diagnosed in 59%. The incidence of BPAR was 13,6%. The rate of CMV was 35,4% and early readmission 28,2%. The medium CrCL after 1 year was 49,4 ± 21,1 ml/min and the graft and patient survival rates were 83,6% and 91,8%, respectively.

Discussion

The clinical outcomes after 12 months are similar to the international results using Thymoglobuline in higher doses. The BPAR rates were acceptable, CMV and DGF affected a third of the cohort, probably becaus of the donor maintenance and the absence of pharmacologic prophylaxis against CMV. There was a considerably high rate of early graft loss (16% in 12 months), with more studies needed.

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