Single-dose rATG induction at renal transplantation: Superior renal function and glucoregulation with less hypomagnesemia

R. Brian Stevens, 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

    Research output: Contribution to journalArticlepeer-review

    17 Scopus citations

    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, rATG S, vs. divided dose, rATG D) 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 sixmonths 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 HbA 1c. Serum Mg ++ was routinely collected and retrospectively analyzed. Results: Induction with rATG S 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 rATG S protects against a synergistic interaction between tacrolimus and sirolimus that otherwise increased hypomagnesemia (p=0.008) and hyperglycemia (p=0.03). Conclusions: rATG S initiated before renal reperfusion improved early renal function and reduced impaired glucose regulation, an injury by diabetogenic maintenance agents (tacrolimus and sirolimus).

    Original languageEnglish (US)
    Pages (from-to)123-132
    Number of pages10
    JournalClinical Transplantation
    Volume26
    Issue number1
    DOIs
    StatePublished - Jan 1 2012

    Keywords

    • Hyperglycemia
    • Hypomagnesemia
    • Kidney transplantation
    • Magnesium
    • New-onset diabetes after transplantation
    • Rabbit anti-thymocyte globulin

    ASJC Scopus subject areas

    • Transplantation

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