ATG induction in renal transplant recipients: Long-term hazard of severe infection is associated with long-term functional T cell impairment but not the ATG-induced CD4 cell decline
Weimer R, Ettrich M, et alHuman Immunology 2014; 75 (6 ): 561–569
Aims
To examine long-term immunological effects of anti-thymocyte globulin (ATG) induction at 2 and 5 years post-transplant
Interventions
44 of the 84 patients received prophylactic rabbit ATG (4 mg/kg/day) induction therapy postoperatively because of an increased immunological risk profile. The mean duration of ATG treatment was 8.6 ± 0.4 days.
Participants
44 of the 84 patients received prophylactic rabbit ATG (4 mg/kg/day) induction therapy
Outcomes
Peripheral blood mononuclear cell subsets, intracellular cytokine determination, T cell proliferative capacity and CD4+ T cell helper activity.
Follow-up
5 years
CET Conclusions
This is an interesting study, although not strictly a randomised trial, comparing ATG (Fresenius) induction against non ATG induction. The patients (n= 83), have been selected from a trial of three different maintenance regimens in which ATG was used for induction in immunologically high risk recipients but not in low risk recipients. The patients who received ATG had a significant depletion of CD4+ T cells which was still present 5 years after transplantation. There was a significant increase in severe infections, especially upper respiratory tract infection and varicella zoster infection, in the patients who received ATG, but this was not associated with the depletion of CD4+ T cells but was associated with a decrease in T cell function. Thus it was in the patents who had a significant reduction in T cell function over 5 years who developed severe infections although these all occurred in the first two years after transplantation. This risk of increased infection was not associated with the CD4 T cell level but rather with impaired T cell function.
Data analysis
Per protocol analysis
Trial registration
ClinicalTrials.gov - NCT00150891