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Thymoglobulin dosing in obese patients pulmonary: Immunosuppression Dosing in Obese Solid Organ Transplant Recipients

Arthritis Rheum. To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation.

Matthew Cox
Wednesday, March 31, 2021
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  • Everolimus versus mycophenolate mofetil in heart transplantation: a randomized, multicenter trial.

  • Tolerance and chimerism after renal and hematopoietic-cell transplantation.

  • The decision pulmonart administer rATG or other induction therapy after kidney transplantation is based on demographic characteristics such as age and race, taking into account other clinical factors such as previous transplantation and the type of donor. Randomized trials and non-randomized trials of rATG during the s and early s established the immunosuppressive potency of rATG for both the treatment and prevention of solid organ graft rejection, but also highlighted safety concerns.

  • Earn up to 6 CME credits per issue. Hayes D.

  • Ischemic cholangiopathy is a major cause of liver graft loss in patients undergoing a liver transplantation from donors after cardiac death and this potentially important finding requires examination in further studies.

Key Points

Brennan et al. Prospective Randomized Thymolobulin. Induction comprised a day course of rATG, at an unspecified dose. The DGFS: a useful scoring system for the prediction and management of delayed graft function following kidney transplantation from cadaveric donors. As experience with rATG grew during the late s and early s, it became apparent that the high doses of rATG typically 1.

Assessing an enoxaparin dosing protocol in morbidly obese patients. A prospective, randomized, clinical trial of intraoperative versus postoperative Thymoglobulin in adult cadaveric renal obede recipients. Blood Cells Mol Dis. Induction therapy with basiliximab versus Thymoglobulin in African-American kidney transplant recipients. Cited by: 0 articles PMID: As experience with rATG grew during the late s and early s, it became apparent that the high doses of rATG typically 1. Tacrolimus MMF Steroids.

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Induction dog with rabbit antithymocyte globulin versus basiliximab in renal transplant ghymoglobulin with planned early steroid withdrawal. Mean SD total dose 3. These results indicate that rATG can be given to high-risk patients before and after an alternative donor stem cell transplant, and this approach further mitigates acute and chronic GvHD without interfering with the graft versus leukemia GvL effect. Use of thymoglobulin induction therapy in the prevention of acute graft rejection episodes following liver transplantation. Reducing Maintenance Immunosuppression In recent years, clinical investigation of rATG in kidney transplantation has centered on its ability to support either early steroid withdrawal or CNI-sparing regimens.

References 1. Mohty M 1. Mohty M, Gaugler B. In pu,monary kidney transplant recipients, good outcomes have been reported with rATG at a dose of 1. French Transplant Centers. Pharmacotherapy26 1201 Dec Clinicians must also be cautious in management of AAD therapy in the obese population because pharmacokinetic and pharmacodynamic alterations in extreme body size may result in significant risk and overdosage.

Letters to the Editor

Stevens et al. In one analysis by Carrier et al. In a controlled study of 40 kidney transplants given a total dose oese 1. Randomized controlled trials of autologous hematopoietic stem cell transplantation for autoimmune diseases: the evolution from myeloablative to lymphoablative transplant regimens. The same group has since developed a program of combined HSCT and renal transplantation from HLA-identical family donors, the endpoint being discontinuation of immunosuppression.

In a randomized trial in liver transplant patients, rATG resulted in less clinical evidence thymoglobulin dosing in obese patients pulmonary ischemia-reperfusion injury [ ], but a similar histological study in kidney transplant patients is lacking. Bronchiolitis obliterans syndrome: the final frontier for lung transplantation. Wong et al. Clinically, a retrospective study of rATG induction with intravenous immunoglobulin IVIG in kidney transplant patients with preformed DSA receiving tacrolimus-based triple therapy has demonstrated that sensitized patients with positive flow cytometry cross-match can achieve excellent graft survival rates with acceptable levels of antibody-mediated rejection [ ]. Dabigatran versus warfarin in patients with atrial fibrillation.

Islet transplantation in type I diabetes mellitus. Tacrolimus MMF withdrawn after month 3. Steroid withdrawal at month 3 from a maintenance regimen of cyclosporine and MMF also appears feasible based on data from a randomized, double-blind trial reported by Lebranchu et al. ISHLT; pp.

Expert Analysis

IL-2RA induction 1. First U. Similar Articles To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation. Haematologica601 Jun

  • Preliminary results with early corticosteroid withdrawal in African American renal allograft recipients. Prednisone-free maintenance immunosuppression: a 5-year experience.

  • In recent years, clinical investigation of rATG in kidney transplantation has centered on its ability to support either early steroid withdrawal or CNI-sparing regimens. In this trial, 72 patients received rATG 1.

  • More recent reports of near-total or full-face transplants, including rATG induction therapy, have reported similarly successful outcomes [].

  • The decision to administer rATG or other induction therapy after kidney transplantation is based on demographic characteristics such as age and race, taking into account other clinical factors such as previous transplantation and the type of donor.

Open in a separate window. Schmauss D, Weis M. IL-2RA induction Brennan et al. Evidence from the pivotal trials of DOACs suggests that current dosing is safe and effective in obese patients, suggesting that an "obesity paradox" is present in patients with AF. A recent retrospective case-control series also indicated that in patients undergoing a second kidney transplant, rATG induction achieves similar lymphocyte depletion to that observed after a first course, and is as well tolerated [ 98 ].

Andreas Zuckermann has received research funding and is a member of an advisory board for Sanofi-Genzyme. Comparison of polyclonal induction agents in pediatric renal transplantation. Thymoglobulin induction and sirolimus versus tacrolimus in kidney transplant recipients receiving mycophenolate mofetil and steroids. Treatment of autoimmune disease with rabbit anti-T lymphocyte globulin: clinical efficacy and potential mechanisms of action. Collaborative Transplant Study —

  • The Registry of the International Society for Heart and Lung Transplantation: 29th adult lung and heart-lung transplant report

  • A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.

  • Yale J Biol Med. Prospective randomized study of low dose antithymocyte globulin as induction in non sensitized adult renal transplant recipients [abstract no.

  • Induction therapy in lung transplantation.

  • Am J Cardiol ; Barras M, Legg A.

Thymoglobulin dosing in obese patients pulmonary prospective randomized trial of steroid-free maintenance thy,oglobulin in kidney transplant recipients—an interim analysis. Schenker et al. In a comparative trial of cyclosporine versus tacrolimus with MMF and steroids, both groups received rATG at a total dose of 7. Induction comprised a day course of rATG, at an unspecified dose. Although limited by retrospective healthcare claims data, which innately pose risk for inaccuracies, this study included a large population and supported the use of rivaroxaban in morbidly obese patients with AF. There are limited data from patients treated with ATG-Fresenius to suggest that an effect on CAV may be dose-dependent [ ], but an effect using modern rATG dose levels appears possible [ ] and further investigation is merited. Posttransplantation lymphoproliferative disorder in kidney and heart transplant recipients receiving thymoglobulin: a systematic review.

Data are more limited in heart transplantation [ 74 — 77 ]. In more recent years a role for rATG has also been established in less aggressive non-myeloablative and reduced-intensity conditioning regimens [ 3 ]. Mourad et al. Boillot et al. Steroid withdrawal for pancreas after kidney transplantation in recipients on maintenance prednisone immunosuppression. Clinical data are not adequate to assume a benefit for rATG in terms of diminishing injury.

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Am J Transplant. The rate of post-transplant infections was similar in both arms. CD3 monitoring and thymoglobulin therapy in cardiac transplantation: clinical outcomes and pharmacoeconomic implications. In all but one randomized trial [ 50 ], renal function was superior at 1 year in the CNI-free arm, either overall [ 4851 ] or among the subpopulation who remained on a CNI-free regimen [ 49 ].

InKrasinskas et al. Am J Nephrol. Antithymocyte globulin induction is associated with improved graft survival and reduced ischemic cholangiopathy after DCD liver transplantation as compared to basiliximab [abstract no. Rates of relapse and survival were comparable.

A randomized prospective study comparing low-dose OKT3 to low-dose ATG for the treatment of acute steroid-resistant rejection episodes in kidney transplant recipients. The addition of rATG induction to a standard triple or dual regimen reduces acute cellular rejection, and possibly humoral rejection. The risk of cancer is estimated to be twice as high in solid organ transplant recipients as thymoglobulin dosing the general population, with the difference most marked for infection-related malignancy diagnosis such as non-Hodgkin lymphoma [ ]. Generally, BK virus infection is considered to be associated with any intensive immunosuppressive regimen rather than a specific agent [ ], and no direct link to rATG therapy has been established [ ]. In the relatively new field of islet transplantation, there is some initial positive experience with an immunosuppression regimen of rATG induction, tacrolimus, and MMF [ ], and studies are ongoing [ ]. Nevertheless, there is a growing movement towards inclusion of DSA during risk stratification of transplant recipients in order to target rATG induction and other interventions appropriately. However, perhaps of more interest is adaptation of dosing based on T-cell count, which has been explored in kidney and heart transplantation Table 1.

Publication types

This article has been cited by other articles in PMC. Excellent renal allograft survival in donor-specific antibody positive transplant patients-role of intravenous immunoglobulin and rabbit antithymocyte globulin. A randomized trial of three renal transplant induction antibodies: early comparison of tacrolimus, mycophenolate mofetil, and steroid dosing, and newer immune-monitoring.

  • Andrew Mardis, Caitlin R.

  • Using weight-adjusted dosing, caution should be exercised in patients with body weight below 40 kg patienys greater than 80 kg, to avoid under- or over-immunosuppression. To the Editor: We read the article on venous thromboembolism VTE with interest and appreciate that the authors highlight the different treatment options for this disease state.

  • Depending on the adjunctive conditioning regimen, relatively low doses have proved effective.

  • In this trial, 72 patients received rATG 1. Preferential increase in memory and regulatory subsets during T-lymphocyte immune reconstitution after Thymoglobulin induction therapy with maintenance sirolimus vs cyclosporine.

More recently, Harrison and colleagues observed no difference in renal function during the first year post-transplant in patients given the first rATG dose before reperfusion or postoperatively [ ]. Ann N Y Acad Sci. Open in a separate window. One retrospective study has compared rATG induction 6.

In one trial, a non-significant trend to improved rates of response and prevention of recurrent rejection was observed versus muromonab-CD3 OKT3with a more favorable safety profile [ 14 ]. Accessed May 28, Total 3. Donor-specific antibodies adversely affect kidney allograft outcomes.

Cited by: 14 articles PMID: Despite its long history, rATG remains a key component of the immunosuppressive armamentarium, and its complex immunological properties indicate that its use will expand out of breath easily obese dog a wider range of disease conditions in the future. Immunosuppression with antithymocyte globulin in renal transplantation: better long-term graft survival. Horse versus rabbit antithymocyte globulin in acquired aplastic anemia. Generally, BK virus infection is considered to be associated with any intensive immunosuppressive regimen rather than a specific agent [ ], and no direct link to rATG therapy has been established [ ].

Induction with rATG in liver transplant patients receiving a standard triple or dual regimen has been compared with no induction in two single-center, randomized trials [] Table 4. Tacrolimus MMF Low-dose steroids. Prospective Single-arm Single-center. The LMWH agent enoxaparin Lovenox has no official dosing recommendations for these patients, 3 but data in this population suggest that a reduced weight-based dose less than 1 mg per kg is warranted. J Thromb Haemost ;

The overall incidence of PTLD was 0. Support Center Support Center. Cardiac allograft vasculopathy: recent developments. Task Force 2: immunosuppression and rejection.

Generally, BK virus infection is considered to be associated with any intensive immunosuppressive regimen rather than a specific agent thymoglobulni ], and no direct link to rATG therapy has been established [ ]. French multicenter year experience in stem cell transplantation for beta-thalassemia major: lessons and future directions. The intensity of immunosuppression in the everolimus arm rATG, everolimus, CNI, and steroids appears to have over-immunosuppressed patients.

Prospective Randomized Single-center. The rate of post-transplant infections patienhs similar in both arms. Rapid discontinuation of prednisone in higher-risk kidney transplant recipients. Multivariate analysis of antibody induction therapy and their associated outcomes in deceased donor transplants. I agree, dismiss this banner. Outcome of induction immunosuppression for liver transplantation comparing anti-thymocyte globulin, daclizumab, and corticosteroid.

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Transplant Rev Orlando ; 26 — A randomized, prospective, pharmacoeconomic trial of tacrolimus versus cyclosporine in combination with thymoglobulin in renal transplant recipients. In addition to its current applications in solid organ transplantation, there is growing interest in the potential to harness the biological effects of rATG beyond T-cell depletion. Smart citations by scite. Clinically, a retrospective study of rATG induction with intravenous immunoglobulin IVIG in kidney transplant patients with preformed DSA receiving tacrolimus-based triple therapy has demonstrated that sensitized patients with positive flow cytometry cross-match can achieve excellent graft survival rates with acceptable levels of antibody-mediated rejection [ ].

More recently, Harrison and colleagues observed no difference in renal function during the first year post-transplant in patients given the first rATG dose before reperfusion or postoperatively [ ]. Thymoglobulin dosing in obese patients pulmonary therapy with rabbit antithymocyte globulin. In autoimmunity, rATG contributes to the treatment of severe aplastic anemia, and has been incorporated in autograft projects for the management of conditions such as multiple sclerosis, Crohn's disease, and systemic sclerosis. Plast Reconstr Surg. While all relevant publications were reviewed, emphasis is placed on randomized trials where possible. Purchase Access: See My Options close. Am J Transplant.

Zuckermann A. Proarrhythmia and sudden cardiac death are significant risks associated with use of select AADs and, in most cases, dose dependent. Abou-Ayache et al. Clin Infect Dis.

  • A retrospective, single-center analysis of SPK procedures performed during — indicated a lower rate of both acute rejection overall and steroid-resistant rejection, with similar graft and patient survival rates and safety profiles, but rATG dosing and maintenance immunosuppression evolved over the study period and the findings are not necessarily applicable to current regimens [ ].

  • Five-year outcomes from a randomized trial of patients with hematologic malignancies receiving reduced-intensity conditioning with fludarabine and either rATG 2. In one trial, a non-significant trend to improved rates of response and prevention of recurrent rejection was observed versus muromonab-CD3 OKT3with a more favorable safety profile [ 14 ].

  • Induction immunosuppression improves long-term graft and patient outcome in organ transplantation: an analysis of United Network for Organ Sharing registry data. As with the general population, the rates of obesity among transplant recipients continue to increase, and some patients continue to gain weight following transplantation.

  • Data from patients receiving ATG-Fresenius are consistent with these findings []. Am J Health Syst Pharm.

In a comparative trial of cyclosporine versus tacrolimus with Thymoglobulin dosing in obese patients pulmonary and steroids, both groups received rATG at a total dose of 7. Regardless of which body weight is used, tacrolimus therapeutic drug monitoring should be employed to achieve appropriate trough concentrations as determined by patient-specific factors and center protocols. Effect on cytokine release and graft-versus-host disease of different anti-T cell antibodies during conditioning for unrelated haematopoietic stem cell transplantation. However, close monitoring remains mandatory and includes both short-term evaluation of blood T-cell depletion and longer-term assessment of immune reconstitution [ 9 ].

Tolerogenic immunosuppression for organ transplantation. In a non-randomized trial, Agha et al. Methodology A literature search on the PubMed database was undertaken with no time limits. Currently, this complication can be prevented through close and regular monitoring of EBV reactivation and use of pre-emptive therapy with rituximab. Adverse events, notably fevers and chills, and hematological abnormalities such as lymphopenia, neutropenia, and thrombocytopenia, can occur but are usually managed successfully by dose adjustments. Prospective [ 2364 ] and retrospective [ 64 ] studies indicate that the total dose of rATG can be reduced markedly [ 2379 ] without compromising lymphocyte suppression or immunosuppressive potency.

Key Points

Transpl Immunol32 330 Apr Because current AF therapies will not correct the underlying pathophysiological electrical dysfunction caused by obesity, it is essential that providers encourage lifestyle strategies to improve cardiovascular disease outcomes such as increased physical activity and healthy dietary interventions. Concerns about infectious complications associated with rATG therapy focus on viral infections, most notably CMV infection. Induction therapy in lung transplantation. Following a gradual decline over time, the typical dose of rATG now used in kidney transplant patients receiving a standard triple-dose maintenance regimen is 6.

Adjusted risk of infection for ATG vs. Alemtuzumab with rapid steroid taper in simultaneous kidney and pancreas transplantation: comparison to induction with antithymocyte globulin. T-cell-depleting antibodies and risk of cancer after transplantation. All patients received conditioning with fludarabine, and were randomized to either receive rATG at a low total dose 2. Organ Procurement and Transplant Network — Both mycophenolate products have a recommendation for a fixed-dose dosing strategy rather than weight-based in adult patients and dosing based on body surface area doses for pediatric patients.

Earn up to 6 CME credits per issue. J Cardiothorac Surg. I agree, dismiss this banner. Bone marrow versus peripheral blood as the stem cell source for sibling transplants in acquired aplastic anemia: survival advantage for bone marrow in all age groups. Sweet SC.

At this milestone in its development, it is timely to focus on the most recent clinical data regarding the use of rATG based on contemporary treatment protocols. The use of rATG ib with stem cell transplantation with the ultimate goal of achieving operational tolerance after allografting shows promise, although clinical data to date is highly preliminary [ 3— ]. Experimental evidence [ 81 — 83 ] and preliminary evidence from liver transplantation [ ] that ATG preparations may reduce ischemia-reperfusion injury, which, by limiting immunologic damage [ ], could potentially attenuate cardiac allograft vasculopathy CAV [ 77 ].

Dharnidharka et al. One-year results of a double-blind, randomized, multicenter study comparing normal dose versus low-dose and withdrawal of steroids. Impact of thymoglobulin prior to pediatric unrelated umbilical cord blood transplantation on immune reconstitution and clinical outcome. Studies assessing the feasibility of CNI- or steroid-sparing regimens using rATG induction in lung transplant patients are lacking. A more recent potential safety issue to emerge is whether rATG therapy could impact on the risk of BK virus infection after kidney transplantation. Rabbit ATG for aplastic anaemia treatment: a backward step?

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Schmauss D, Weis M. Mycophenolate mofetil is a prodrug of MPA, which is rapidly hydrolyzed to the active MPA, and was developed to improve bioavailability. Reduced intensity conditioning using intravenous busulfan, fludarabine and rabbit ATG for children with nonmalignant disorders and CML. A prospective randomized controlled study on the efficacy and tolerance of two antilymphocytic globulins in the prevention of rejection in first-heart transplant recipients. Epstein-Barr Virus Reactivation and Lymphoproliferative Diseases The risk of EBV reactivation is increased in patients receiving high doses of ATG in the conditioning regimen [ ], and may lead to potentially life-threatening lymphoproliferative disorders [ ].

First U. CMV pneumonitis is also believed to contribute to the development of BOS [], heightening the potential impact of over-immunosuppression. N Engl J Med. A three-arm study comparing immediate tacrolimus therapy with antithymocyte globulin induction therapy followed by tacrolimus or cyclosporine A in adult renal transplant recipients. Infection and malignancy after pediatric transplantation: the role of induction therapy. Immunosuppression and the risk of post-transplant malignancy among cadaveric first kidney transplant recipients.

This article has been corrected. Eur Heart J ; Early outcomes of thymoglobulin and basiliximab induction in kidney transplantation: application of statistical approaches to reduce bias in observational comparisons.

Multivariate analysis showed that rATG dosig was associated with a significant reduction in risk of both de novo DSA thymoglobulin dosing in obese patients pulmonary acute antibody-mediated humoral rejection [ 32 ] Table 3. In vivo B-cell depletion with rituximab for alternative donor hemopoietic SCT. Delgado et al. Inferior kidney allograft outcomes in patients with de novo donor-specific antibodies are due to acute rejection episodes. Drug dosing in obese adults. Antithymocyte globulin induction is associated with improved graft survival and reduced ischemic cholangiopathy after DCD liver transplantation as compared to basiliximab [abstract no. Bustami et al.

Typically, rATG is now given at a total dose ranging between 4. In recent years, clinical investigation of thymoglobulin dosing in obese patients pulmonary in kidney dosimg has centered on its ability to support either early steroid withdrawal or CNI-sparing regimens. Identifying risk profiles in liver transplant candidates and implications for induction immunosuppression. The incidence of moderate acute rejection was 0, Calcineurin inhibitor-free monotherapy in human leukocyte antigen-identical live donor renal transplantation. Thymoglobulin and ischemia reperfusion injury in kidney and liver transplantation. In one study, a dose of 1.

Epidemiology of BK virus in renal allograft thymoglobuin independent risk factors for BK virus replication. Rabbit antithymocyte globulin as induction immunotherapy for pediatric deceased donor kidney transplantation. The authors concluded that the latter regimen was optimal for balancing the risks of rejection and infection [ ]. Jared P. Epidemiology of posttransplant lymphoproliferative disorders in adult kidney and kidney pancreas recipients: report of the French registry and analysis of subgroups of lymphomas.

  • The same group has since developed a program of combined HSCT and renal transplantation from HLA-identical family donors, the endpoint being discontinuation of immunosuppression.

  • Basiliximab and rabbit anti-thymocyte globulin for prophylaxis of acute rejection after heart transplantation: a non-inferiority trial.

  • Lo et al. Pediatr Transplant.

  • Lastly, intraoperative administration of the first dose may help to minimize the risk of DGF in at-risk kidney transplant recipients [ 2080 ], possibly by ameliorating ischemia-reperfusion injury through suppression of inflammatory cells and mediators as a result of leukocyte and T-lymphocyte depletion [ 81 — 83 ], but this remains unconfirmed.

  • Due to minimal representation of morbidly obese patients in the pivotal DOAC trials, as well as limited pharmacokinetic and pharmacodynamic data in this population, several retrospective studies have been conducted to determine whether DOACs are a safe and effective alternative compared with warfarin in this population.

Faouzi Saliba Search articles by 'Faouzi Saliba'. Ni Prophylaxis and Graft Survival The efficacy of rATG in preventing acute rejection in kidney transplant patients is well-established [ 389 ]. Antithymocyte globulin induction therapy in hepatitis C-positive liver transplant recipients. McCauley et al. In vivo B-cell depletion with rituximab for alternative donor hemopoietic SCT.

Thymoglogulin study of 2 reduced-intensity conditioning strategies for human leukocyte antigen-matched, related allogeneic peripheral blood stem cell transplantation: prospective thymoglobulin dosing in obese patients pulmonary and socioeconomic evaluation. HLA-mismatched renal transplantation without maintenance immunosuppression. It is now the most widely prescribed induction agent in the US [ 1 ], administered to approximately half of all de novo kidney transplant recipients [ 2 ]. Although the evidence base is incomplete, specific roles for rATG in organ transplant recipients using contemporary dosing strategies are now relatively well-identified. More controversial, single-arm studies [] and randomized, controlled trials [ 48 — 51 ] have administered rATG induction with an entirely CNI-free, sirolimus-based maintenance immunosuppressive regimen Table 2. The ORION Study: comparison of two sirolimus-based regimens versus tacrolimus and mycophenolate mofetil in renal allograft recipients.

IL-2RA induction 1. Andrew Mardis, Caitlin R. Total and active rabbit antithymocyte globulin rATG; Thymoglobulin pharmacokinetics in pediatric patients undergoing unrelated donor bone marrow transplantation.

Transplant Int. Andreas Zuckermann has received research funding pwtients is a member of an advisory board for Sanofi-Genzyme. Methodology A literature search on the PubMed database was undertaken with no time limits. A thymoglobulin dosing in obese patients pulmonary proposed scale to classify patients according to their DGF risk [ ] may help identify high-risk individuals. Cyclosporine A versus tacrolimus in combination with mycophenolate mofetil and steroids as primary immunosuppression after lung transplantation: one-year results of a 2-center prospective randomized trial. Although the drug is approved in this setting, treatment of established severe acute GvHD has been less satisfactory. Short-term induction therapy with anti-thymocyte globulin and delayed use of calcineurin inhibitors in orthotopic liver transplantation.

Due pztients minimal representation of morbidly obese patients in the pivotal DOAC trials, as well as limited pharmacokinetic and pharmacodynamic data in this population, several retrospective studies have been conducted thymoglobulin dosing in obese patients pulmonary determine whether DOACs are a safe and effective alternative compared with warfarin in this population. Five-year follow-up data from the Spiesser study [ 49 ] confirmed that estimated glomerular filtration rate GFR remained higher in the CNI-free treatment group, with no difference in acute rejection rates [ ]. However, DSA measurement by the Luminex technique is not always reproducible and suitable cutoff points using other detection techniques, such as complement-dependent cytotoxicity CDC cross-match, have not been established. Brennan et al. Retrospective analyses of data from the ISHLT registry have shown that induction therapy generally is associated with a reduced risk of BOS, presumably due to reduced rejection [, ].

Safety and early outcomes using a corticosteroid-avoidance immunosuppression protocol in pediatric heart transplant recipients. Comparative trials versus IL-2RA agents or other induction therapies are lacking in liver transplant patients. The results indicate that DOACs provide consistent efficacy and safety compared with warfarin across all categories of BMI, but weight categories vary among trials, with small representations of the morbidly obese population. Eason et al.

Epidemiology of posttransplant lymphoproliferative disorders in adult kidney and kidney pancreas recipients: report of the French registry and analysis of subgroups of lymphomas. In our experience, treatment of acute VTE in patients who are morbidly obese is most safely achieved by using intravenous unfractionated heparin and concomitant warfarin. As with standard maintenance immunosuppression, the dose of rATG administered in patients receiving a steroid-sparing regimen has declined over time Fig.

CNI- and steroid-free immunosuppression after simultaneous pancreas-kidney transplantation: one-year results thymoglobulin dosing in obese patients pulmonary a prospective and randomized study. Thymoglobulin induction in liver transplant recipients with a tacrolimus, mycophenolate mofetil, and steroid immunosuppressive regimen: a five-year randomized thymiglobulin study. Relative risk of non-Hodgkin lymphoma vs. With follow-up to 5 years [ ] or 3 months [ ], there were no significant differences in acute rejection, graft or patient survival in either trial, although one trial noted a longer mean time to rejection [ ] and the other reported a shorter hospital stay [ ] in the rATG cohorts. CD3 monitoring and thymoglobulin therapy in cardiac transplantation: clinical outcomes and pharmacoeconomic implications.

Management of acquired aplastic anemia in children. Small thymoglobulin dose adjustments have profound impact on early rejections in renal transplantation [abstract no. The impact of obesity and its sequelae have been well documented in kidney transplantation. Results of the double-blind, randomized, multicenter, phase III clinical trial of Thymoglobulin versus Atgam in the treatment of acute graft rejection episodes after renal transplantation. Sirolimus Reduced tacrolimus Steroids.

However, other single-center, retrospective analyses have observed thymogolbulin difference in DSA production in kidney transplant patients with or without rATG induction []. Obese patients for BK virus: incidence, risk factors, and outcomes for kidney transplant recipients in the United States. The role of Thymoglobulin induction in kidney transplantation: an update. A prospective, randomized, double-blind, placebo-controlled multicenter trial comparing early 7 day corticosteroid cessation versus long-term, low-dose corticosteroid therapy. Influence of polyclonal antithymocyte globulins on the expression of adhesion molecules of isolated human umbilical vein endothelial cells.

Tacrolimus MMF Low-dose steroids. Transplant Res. The multifactorial etiology of DGF means it is difficult to confirm a contribution obese patients rATG induction conclusively, but it appears that rATG may offer some benefit in decreasing the risk of DGF [ ]; further data are awaited. Early published studies of rATG dosing indicate that lower doses were used in lung transplant recipients than in other types of solid organ transplantation []. Review article: use of induction therapy in liver transplantation. Bronchiolitis obliterans syndrome: the final frontier for lung transplantation.

Randomized phase II trial comparing two dose levels of thymoglobulin in patients undergoing unrelated donor thymoglobulij cell transplant. Thymoglobulin dosing in obese patients pulmonary withdrawal for pancreas after kidney transplantation in recipients on maintenance prednisone immunosuppression. Arthritis Rheum. Bone marrow transplantation for severe aplastic anemia: a randomized controlled study of conditioning regimens. Immunoprophylaxis with basiliximab compared with antithymocyte globulin in renal transplant patients receiving MMF-containing triple therapy. This is comparable with published incidence rates for the kidney transplant population as a whole [].

Following a gradual decline over time, the thymoglobulin dosing in obese patients pulmonary dose of rATG now used in kidney transplant patients receiving a standard triple-dose maintenance regimen is 6. One recent analysis of graft survival rates, based on data from the OPTN for kidney transplants during —, reported a lower 6-month incidence of a combined endpoint of rejection, graft failure or death with rATG versus IL-2RA induction or no induction [ ]. Gajarski et al. In this trial, 72 patients received rATG 1.

The authors concluded that an rATG dose of 4. Pediatric Heart Transplant Study Investigators. Initial experience in umbilical cord transplantation, an alternative to conventional allogeneic stem cell transplantation, suggests that the use of rATG as part of the pre-transplant conditioning regimen may improve outcomes and ameliorate GvHD [ ].

These promising data await confirmation in other controlled trials. Letters submitted for publication in AFP must not be submitted to any other publication. In a series of moderately sensitized DSA-positive patients, occurrence of de novo DSA defined as absence of pre-transplant DSA increasing at least threefold was monitored for a mean of Among patients with a primary outcome, median weights and BMIs were also similar.

The role of Thymoglobulin induction in kidney obes an update. Use of thymoglobulin patients pulmonary therapy in the prevention of acute graft rejection episodes following liver transplantation. National Center for Biotechnology InformationU. Only articles with an English abstract were reviewed. The grouping of overweight and obese patients into one category, however, does limit the applicability of this data. The first randomized trials of rATG were comparative studies versus other lymphocyte-depleting agents for the treatment of allograft rejection following kidney transplantation [ 1314 ]. Randomized phase II trial comparing two dose levels of thymoglobulin in patients undergoing unrelated donor hematopoietic cell transplant.

Transplant Direct6 9 :e, 21 Aug Int Immunopharmacol. Woodle et al. The use of rATG induction oulmonary facilitate delayed introduction of CNI therapy by thymoglobulin dosing in obese patients pulmonary to 9 days—often in an attempt to avoid DGF—has been shown to maintain immunosuppressive efficacy following kidney transplantation [ 16244793 ] and is a recognized therapeutic strategy in patients at risk of DGF. Mechanisms involved in antithymocyte globulin immunosuppressive activity in a nonhuman primate model. Early published studies of rATG dosing indicate that lower doses were used in lung transplant recipients than in other types of solid organ transplantation []. Hardinger KL.

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