Poor Patient and Graft Outcome After Induction Treatment by Antithymocyte Globulin in Recipients of a Kidney Graft After Nonrenal Organ Transplantation

Hoa-Le Mai; Michèle Treilhaud; Shani Leviatan Ben-Arye; Hai Yu; Hélène Perreault; Evelyn Ang; Katy Trebern-Launay; Julie Laurent; Stephanie Malard-Castagnet; Anne Cesbron; Thi van Ha Nguyen; Sophie Brouard; Lionel Rostaing; Pauline Houssel-Debry; Christophe Legendre; Sophie Girerd; Michèle Kessler; Emmanuel Morelon; Antoine Sicard; Valérie Garrigue; Georges Karam; Xi Chen; Magali Giral; Vered Padler-Karavani; Jean-Paul Soulillou

doi:10.1097/TXD.0000000000000772

Journal articles

Poor Patient and Graft Outcome After Induction Treatment by Antithymocyte Globulin in Recipients of a Kidney Graft After Nonrenal Organ Transplantation

Hoa-Le Mai ^{1, 2} Michèle Treilhaud ³ Shani Leviatan Ben-Arye ⁴ Hai Yu ⁵ Hélène Perreault ⁶ Evelyn Ang ^{6, 7} Katy Trebern-Launay ^{1, 2} Julie Laurent ⁸ Stephanie Malard-Castagnet ⁹ Anne Cesbron ⁹ Thi van Ha Nguyen ^{1, 2} Sophie Brouard ^{1, 2} Lionel Rostaing ¹⁰ Pauline Houssel-Debry ¹¹ Christophe Legendre ¹² Sophie Girerd ¹³ Michèle Kessler ¹³ Emmanuel Morelon ^{14, 15} Antoine Sicard ^{15, 14} Valérie Garrigue ¹⁶ Georges Karam ¹⁷ Xi Chen ⁵ Magali Giral ^{2, 1} Vered Padler-Karavani ⁴ Jean-Paul Soulillou ^{1, 2}

1 U1064 Inserm - CRTI - Centre de Recherche en Transplantation et Immunologie

2 ITUN - Institut de transplantation urologie-néphrologie

3 CHU Nantes - Centre hospitalier universitaire de Nantes

4 Department of Cell Research and Immunology

5 Department of Chemistry Davis

6 Department of Chemistry [Winnipeg, MB, Canada]

7 Manitoba Centre for Proteomics and Systems Biology [Winnipeg, MB, Canada]

8 Methodomics

9 Etablissement Français du Sang [Nantes]

10 Département de Néphrologie et Transplantation d'organes

Hôpital de Rangueil

11 Service de Chirurgie Hépatobiliaire et Digestive

12 Service Néphrologie et transplantation rénale Adultes [CHU Necker]

13 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy

14 Service de Transplantation, Néphrologie et Immunologie Clinique [Hôpital Edouard Herriot, HCL]

15 Lymphocytes B effecteurs et à mémoire – Effector and memory B cells

CIRI - Centre International de Recherche en Infectiologie - UMR

16 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]

17 Service d'urologie

Abstract : BACKGROUND: End-stage renal failure occurs in a substantial number of patients having received a nonrenal transplantation (NRT), for whom a kidney transplantation is needed. The medical strategy regarding the use of immunosuppression (IS) for a kidney graft in patients after an NRT is not well established. The prekidney grafts long-term IS advocates for a mild induction, such as using anti-IL-2R antibodies, whereas addition of new incompatibilities and anti-HLA preimmunization may suggest using stronger IS such as induction by polyclonal antithymocyte globulins (ATG). METHODS: We performed Cox multivariate and propensity score analysis of our validated transplant database to study the impact of the type of induction therapy on kidney graft survival of recipients of a kidney graft after NRT. RESULTS: We report here that kidney transplantation after NRT treated with an ATG induction has a poorer outcome (kidney and recipient survival) than that with an anti-IL-2R induction. After accounting for potential baseline differences with a multivariate Cox model, or by adjusting on a propensity score, we found that despite patients having received ATG cumulate more risk factors, ATG appears independently involved. As animal-derived biotherapeutics induce antiglycan antibodies and particularly anti-N-glycolylneuraminic acid (Neu5Gc) IgGs which may activate endothelial cells in patients and grafts, we also investigated the magnitude and the nature of the anti-Neu5Gc elicited by the induction and showed that induction was associated with a shift in anti-Neu5Gc IgG repertoire. Possible reasons and mechanisms of a deleterious ATG usage in these patients are discussed. CONCLUSIONS: Our study suggests that ATG induction after a kidney transplantation in recipients already under maintenance IS for a NRT should be used cautiously.

Keywords : CRTI Team4 Team2

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Journal articles

Domain :

Life Sciences [q-bio] / Immunology

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https://www.hal.inserm.fr/hal-01881120
Contributor : Nicolas Degauque <>
Submitted on : Tuesday, September 25, 2018 - 2:52:06 PM
Last modification on : Saturday, June 6, 2020 - 9:04:03 AM

Poor Patient and Graft Outcome After Induction Treatment by Antithymocyte Globulin in Recipients of a Kidney Graft After Nonrenal Organ Transplantation

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Poor Patient and Graft Outcome After Induction Treatment by Antithymocyte Globulin in Recipients of a Kidney Graft After Nonrenal Organ Transplantation

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