Single-dose rATG induction at renal transplantation: superior renal function and glucoregulation with less hypomagnesemia.

Abstract:

UNLABELLED: BACKGROUND:Rabbit anti-thymocyte globulin (rATG) induction reduces reperfusion injury and improves renal function in kidney recipients by means of properties unrelated to T-cell lysis. Here, we analyze intensive rATG induction (single dose, rATG(S) , vs. divided dose, rATG(D) ) for improved renal function and protection against hyperglycemia. METHODS:Patients without diabetes (n = 98 of 180) in a prospective randomized trial of intensive rATG induction were followed for six months for the major secondary composite end point of impaired glucose regulation (hyperglycemia and new-onset diabetes after transplantation, NODAT). Prospectively collected data included fasting blood glucose and HbA(1c). Serum Mg(++) was routinely collected and retrospectively analyzed. RESULTS:Induction with rATG(S) produced less impaired glucose regulation (p = 0.05), delayed NODAT development (p = 0.02), less hyperglycemia (p = 0.02), better renal function (p = 0.04), and less hypomagnesemia (p = 0.02), a factor associated with a lower incidence of NODAT. Generalized linear modeling confirmed that rATG(S) protects against a synergistic interaction between tacrolimus and sirolimus that otherwise increased hypomagnesemia (p = 0.008) and hyperglycemia (p = 0.03). CONCLUSIONS:rATG(S) initiated before renal reperfusion improved early renal function and reduced impaired glucose regulation, an injury by diabetogenic maintenance agents (tacrolimus and sirolimus).

journal_name

Clin Transplant

journal_title

Clinical transplantation

authors

Stevens RB,Lane JT,Boerner BP,Miles CD,Rigley TH,Sandoz JP,Nielsen KJ,Skorupa JY,Skorupa AJ,Kaplan B,Wrenshall LE

doi

10.1111/j.1399-0012.2011.01425.x

subject

Has Abstract

pub_date

2012-01-01 00:00:00

pages

123-32

issue

1

eissn

0902-0063

issn

1399-0012

journal_volume

26

pub_type

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