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Article
Single-Dose rATG Induction at Renal Transplantation: Superior Renal Function and Glucoregulation with Less Hypomagnesemia
Clinical Transplantation
  • R. Brian Stevens, Wright State University
  • James T. Lane
  • Brian P. Boerner
  • Clifford D. Miles
  • Theodore H. Rigley
  • John P. Sandoz
  • Kathleen J. Nielsen
  • Jill Y. Skorupa
  • Anna J. Skorupa
  • Bruce Kaplan
  • Lucile E. Wrenshall, Wright State University - Main Campus
Document Type
Article
Publication Date
1-1-2012
Abstract
BACKGROUND: Rabbit anti-thymocyte globulin (rATG) induction reduces reperfusion injury and improves renal function in kidney recipients by means of properties unrelated to T-cell lysis. Here, we analyze intensive rATG induction (single dose, rATGS , vs. divided dose, rATGD ) for improved renal function and protection against hyperglycemia. METHODS: Patients without diabetes (n = 98 of 180) in a prospective randomized trial of intensive rATG induction were followed for six months for the major secondary composite end point of impaired glucose regulation (hyperglycemia and new-onset diabetes after transplantation, NODAT). Prospectively collected data included fasting blood glucose and HbA1c. Serum Mg++ was routinely collected and retrospectively analyzed. RESULTS: Induction with rATGS produced less impaired glucose regulation (p = 0.05), delayed NODAT development (p = 0.02), less hyperglycemia (p = 0.02), better renal function (p = 0.04), and less hypomagnesemia (p = 0.02), a factor associated with a lower incidence of NODAT. Generalized linear modeling confirmed that rATGS protects against a synergistic interaction between tacrolimus and sirolimus that otherwise increased hypomagnesemia (p = 0.008) and hyperglycemia (p = 0.03). CONCLUSIONS: rATGS initiated before renal reperfusion improved early renal function and reduced impaired glucose regulation, an injury by diabetogenic maintenance agents (tacrolimus and sirolimus).
DOI
10.1111/j.1399-0012.2011.01425.x
Citation Information
R. Brian Stevens, James T. Lane, Brian P. Boerner, Clifford D. Miles, et al.. "Single-Dose rATG Induction at Renal Transplantation: Superior Renal Function and Glucoregulation with Less Hypomagnesemia" Clinical Transplantation Vol. 26 Iss. 1 (2012) p. 123 - 132 ISSN: 09020063
Available at: http://works.bepress.com/lucile_wrenshall/15/