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).
- Kidney transplantation
- New-onset diabetes after transplantation
- Rabbit anti-thymocyte globulin
ASJC Scopus subject areas