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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Nephropathol
2015 ; 4
(4
): 110-5
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English Wikipedia
Induction by anti-thymocyte globulins in kidney transplantation: a review of the
literature and current usage
#MMPMID26457257
Malvezzi P
; Jouve T
; Rostaing L
J Nephropathol
2015[Oct]; 4
(4
): 110-5
PMID26457257
show ga
CONTEXT: Preventing acute rejection (AR) after kidney transplantation is of
utmost importance because an AR can have a negative impact on long-term allograft
survival. EVIDENCE ACQUISITION: Directory of Open Access Journals (DOAJ), Google
Scholar, PubMed, EBSCO, and Web of Science have been searched. RESULTS: At the
moment this can be done by using rabbit anti-thymocyte globulins (rATGs) as an
induction therapy. However, because rATGs are associated with some deleterious
side-effects, such as the opportunistic infections cytomegalovirus (CMV) and de
novo post-transplant cancer, it is very important they are used optimally, i.e.,
at minimal doses that avoid many side-effects but still retain optimal treatment
efficacy. Recent data show that the risk of CMV infection can be minimized using
tacrolimus plus everolimus, and not tacrolimus plus mycophenolic acid, as the
maintenance immunosuppression. The use of rATG is particularly valuable in; (a)
sensitized patients; (b) in recipients from an expanded-criteria donor, thus
enabling the introduction of calcineurin inhibitors at reduced doses; and (c) for
patients where steroid avoidance is contemplated. However, we also need to
consider that rATG may increase the risk of de novo cancer, even though recent
data indicate this is unlikely and that any risk can be reduced by using
mammalian target of rapamycin (mTOR) inhibitors instead of mycophenolic acid
combined with low-dose calcineurin inhibitors. CONCLUSIONS: Even though rATGs do
not improve long-term kidney-allograft survival, they may help reduce
calcineurin-inhibitor dosage during the early post-transplant period and minimize
the risk of AR.