Low-Dose Rabbit Antithymocyte Globulin Induction Therapy Results in Prolonged Selective Lymphocyte Depletion Irrespective of Maintenance Immunosuppression

摘要: 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 (7-10 mg/kg) rATG result in profound lymphopenia and predispose patients infection malignancy. The effects lower (LoD-rATG, 3-5 on peripheral blood lymphocytes (PBL) are as yet unknown. In this prospective clinical trial, PBL subsets were characterized by flow cytometry over 12 months LoD-rATG therapy. All initially treated with standard tacrolimus, mycophenolic acid, prednisone. At 3 months, randomized either tacrolimus or sirolimus examine maintenance immunosuppression reemergence. resulted prolonged suppression CD19+ B cells, total CD3+ T well naive memory CD4+ cell CD4/CD25/Foxp3+ T-regulatory irrespective chronic immunosuppressive Selective depletion was only noted CD4CD45RA+ T-cell subset resulting an altered memory/naive ratio. failed deplete CD8+ which increased their relative contribution pool. other lymphocyte maintained near normal proportions. Thus, may lessen adverse full dose while maintaining overall efficacy.