Our initial plan for induction for a patient with a negative crossmatch was rATG alone.
This is the first reported facial VCA utilizing an induction regimen of rATG in combination with rituximab.
Abbreviations AMR: Antibody-mediated rejection BID: Bis in die CNI: Calcineurin inhibitor CDCXM: Complement-dependent cytotoxicity crossmatch DSA: Donor-specific antibodies FCXM: Flow cytometry crossmatch HLA: Human Leukocyte Antigen IL-2: Interleukin 2 IVIG: Intravenous immunoglobulins mTOR: Mechanistic target of rapamycin MChD: Median channel displacement MMF: Mycophenolate mofetil PRA: Panel reactive antibody POD: Postoperative day rATG: Rabbit antithymocyte globulin VCA: Vascularized composite tissue allotransplantation.
Patients that did not respond to hATG after 3 months of treatment, received ATG of rabbit origin (rATG) at a dose of 3.75 mg/kg/day for 5 days and CsA was continued at the same dosage.
Patient characteristics n: 18 Male: female ratio 11: 7 Mean age at the time of diagnosis (years) 7.9 Median age at the time of diagnosis (years) 8 Disease severity at the time of diagnosis Very severe 6 Severe 6 Moderate 6 Patients that received HDMP 9 Patients that responded to treatment 2 Number of immunotherapy courses 1 (hATG) 12 2 (hATG and rATG) 7 Treatment response (to hATG and rATG) Total response 5 Partial response - No response 7 Early Exitus 4 Result Alive without transfusion 7 Alive and dependent on transfusion 4 Early exitus 4 Exitus after the first course 2 Exitus after the second course 1 Response to IST
In total, 9 patients did not respond to 3 months of treatment; 7 subsequently received a second course of 1ST consisting of rATG. Prednisolone treatment was repeated and the patients received CsA treatment as the same dosage for six months.
Severity of Treatment Response Treatment Response Treatment disease group (n) group (n) group HDMP hATG + CsA rATG + CsA (1st (2nd course) course) Moderate (n 3 - 5 2 3 = 6) Severe (n = 3 - 3 - 3 6) Very 3 2 4 1 1 severe (n = 6) 2 3 Severity of Response Overall disease (n) responsenn =14 * Moderate (n 1 3 = 6) Severe (n = 1 1 6) Very - 3 severe (n = 6) 2 %50 * The 4 patients that died during the first month of treatment were excluded In the patients that responded to 1ST the time required for partial or complete response was analyzed.
Clinically, two randomized studies in kidney transplantation have addressed the question of whether rATG can influence the impact of IRI on graft function.
in a rat model of transplantation, where administration of anti-rat rATG to the donor prior to organ retrieval ameliorated IRI, as shown by lower necrosis and apoptosis scores and better early graft function .
The profound suppression of T-cells induced by rATG confers a potent immunosuppressive effect, and its efficacy in preventing acute rejection after kidney transplantation is well-accepted .
published a randomized trial in which 308 patients at varying levels of immunological risk received either rATG (at a total dose of 12.5 mg/kg, starting after surgery) with tacrolimus delayed until day 9 or no induction with tacrolimus started on the day of transplantation .