| Institution: | 1. Department of Surgery, Duke University, Durham, North Carolina, USA;2. Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA;3. Department of Pediatrics, University of California Los Angeles, Los Angeles, California, USA;4. Department of Pediatrics, Stanford University, Stanford, California, USA;5. Department of Pathology, University of California, Los Angeles, California, USA;6. National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, USA;7. Department of Surgery, University of California, San Francisco, California, USA;8. Department of Pediatrics, Children’s Healthcare Atlanta, Atlanta, Georgia, USA;9. Department of Surgery, Stanford University, Stanford, California, USA;10. Department of Surgery, Duke University, Durham, North Carolina, USA
Department of Pediatrics, Duke University, Durham, North Carolina, USA |
| Abstract: | Depletional induction using antithymocyte globulin (ATG) reduces rates of acute rejection in adult kidney transplant recipients, yet little is known about its effects in children. Using a longitudinal cohort of 103 patients in the Immune Development in Pediatric Transplant (IMPACT) study, we compared T cell phenotypes after ATG or non-ATG induction. We examined the effects of ATG on the early clinical outcomes of alloimmune events (development of de novo donor specific antibody and/or biopsy proven rejection) and infection events (viremia/viral infections). Long-term patient and graft outcomes were examined using the Scientific Registry of Transplant Recipients. After ATG induction, although absolute counts of CD4 and CD8 T cells were lower, patients had higher percentages of CD4 and CD8 memory T cells with a concomitant decrease in frequency of naïve T cells compared to non-ATG induction. In adjusted and unadjusted models, ATG induction was associated with increased early event-free survival, with no difference in long-term patient or allograft survival. Decreased CD4+ naïve and increased CD4+ effector memory T cell frequencies were associated with improved clinical outcomes. Though immunologic parameters are drastically altered with ATG induction, long-term clinical benefits remain unclear in pediatric patients. |
