Kidney Week

Abstract: TH-PO820

Rabbit Anti-thymocyte Globulin Induction (rATG) in Older Adult Kidney Transplant Recipients

Session Information

• Transplantation: Clinical - 2
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Trollinger, Brandon L., The Johns Hopkins Hospital, Baltimore, Maryland, United States

Brandon L. Trollinger, PharmD

• Cartus, Rachel, Keck Medicine of USC, Los Angeles, California, United States

Rachel Cartus, PharmD

• Alachkar, Nada, Johns Hopkins University, Baltimore, Maryland, United States

Nada Alachkar, MD, FASN

• Carberry, Heather, Johns Hopkins University, Baltimore, Maryland, United States

Heather Carberry, MS, RN, CPHQ

• Malhotra, Divyanshu, Johns Hopkins University, Baltimore, Maryland, United States

Divyanshu Malhotra, MBBS

• Lees, Laura, The Johns Hopkins Hospital, Baltimore, Maryland, United States

Laura Lees, PharmD

• Philosophe, Benjamin, Johns Hopkins University, Baltimore, Maryland, United States

Benjamin Philosophe, MD, PhD

• Strout, Sara, The Johns Hopkins Hospital, Baltimore, Maryland, United States

Sara Strout, PharmD

• Brennan, Daniel C., Johns Hopkins University, Baltimore, Maryland, United States

Daniel C. Brennan, MD

Background

Deceased donor kidney transplants are increasingly performed in older patients. There are limited published efficacy and safety data of rATG use in this population, particularly in those ≥75 years old.

Methods

This is a single center, real-world retrospective cohort study of 445 first-time kidney-only DDKT recipients ≥40 yo who received rATG induction. Patients were age-stratified: 40-64 yo (middle age, MA), 65-74 yo (older, O), ≥75 yo (oldest old, OO). Dosing, baseline characteristics, efficacy and safety outcomes were analyzed using Kruskal-Wallis or Fisher’s exact tests.

Results

The cohorts (MA: n=284, O: n=133, OO: n=28) showed imbalances in baseline characteristics: race, sensitization, weight and estimated posttransplant survival/kidney donor profile indices (Figure 1). Median rATG dose (mg/kg) decreased with increasing age (MA: 5.0, O: 4.5, OO: 3.1, p<0.01) with lower rejection rates. Death, early cytomegalovirus viremia, cardiovascular events and cancer rates were higher in the older cohorts, but death-censored graft failure and infection were not (Figure 2).

Conclusion

Lower rATG doses effectively prevented rejection with similar graft survival rates in older patients. However, adverse event rates remain higher in these cohorts.