Low-dose rabbit antithymocyte globulin induction therapy results in prolonged selective lymphocyte depletion irrespective of maintenance immunosuppression

O. Pankewycz, N. Leca, R. Kohli, P. K. Wallace, M. Said, L. Feng, Muna A Alnimri, S. Patel, M. R. Laftavi

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Rabbit antithymocyte globulin therapy (rATG) is a potent lymphocyte-depleting agent commonly used following renal transplantation to reduce the risk of acute rejection. Standard doses (710 mg/kg) of rATG result in profound lymphopenia and predispose patients to infection and malignancy. The effects of lower doses of rATG (LoD-rATG, 35 mg/kg) on peripheral blood lymphocytes (PBL) are as yet unknown. In this prospective clinical trial, PBL subsets were characterized by flow cytometry over 12 months following LoD-rATG therapy. All patients were initially treated with standard doses of tacrolimus, mycophenolic acid, and prednisone. At 3 months, patients were randomized to either lower doses of tacrolimus or sirolimus to examine the effects of maintenance immunosuppression on PBL reemergence. LoD-rATG therapy resulted in prolonged suppression of CD19+ B cells, total CD3+ T cells, as well as nave and memory CD4+ T cell and CD4/CD25/Foxp3 + T-regulatory subsets irrespective of chronic immunosuppressive therapy. Selective depletion was only noted in the CD4CD45RA+ nave T-cell subset resulting in an altered memory/nave CD4+ ratio. LoD-rATG failed to deplete CD8+ T cells, which increased their relative contribution to the total CD3+ pool. All other lymphocyte subsets maintained near normal proportions. Thus, LoD-rATG therapy may lessen the adverse effects of full dose rATG while maintaining overall efficacy.

Original languageEnglish (US)
Pages (from-to)462-465
Number of pages4
JournalTransplantation Proceedings
Volume43
Issue number2
DOIs
StatePublished - Mar 2011
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Transplantation

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