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 journalArticle

15 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 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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    Stevens, R. B., Lane, J. T., Boerner, B. P., Miles, C. D., Rigley, T. H., Sandoz, J. P., Nielsen, K. J., Skorupa, J. Y., Skorupa, A. J., Kaplan, B., & Wrenshall, L. E. (2012). Single-dose rATG induction at renal transplantation: Superior renal function and glucoregulation with less hypomagnesemia. Clinical Transplantation, 26(1), 123-132. https://doi.org/10.1111/j.1399-0012.2011.01425.x