{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:29:14Z","timestamp":1753878554261,"version":"3.41.2"},"reference-count":39,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,12,19]],"date-time":"2020-12-19T00:00:00Z","timestamp":1608336000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Currently, there is limited literature evaluating rATG induction dosing and incidence of opportunistic viral infections when using steroid\u2010free maintenance immunosuppression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This single\u2010center, retrospective, study compared high rATG (&gt;4.5\u00a0mg\/kg) versus low (&lt;4.5\u00a0mg\/kg) induction dosing and the overall incidence of early opportunistic viral infection at 180\u00a0days in the setting of maintenance immunosuppression consisting of tacrolimus, mycophenolate, rapid steroid withdrawal, and a tiered antiviral prevention strategy based on donor\u2010recipient Cytomegalovirus (CMV) serostatus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 209 patients were included; 76 patients received low\u2010dose and 133 patients received high\u2010dose rATG. Incidence of overall opportunistic viral infection occurred more frequently in patients who received high compared to low dose (29.8% vs 25% <jats:italic>p<\/jats:italic>\u00a0=\u00a0.030). Incidence of CMV infection was also significantly increased in the high\u2010dose group (31.6% vs 18.4% <jats:italic>p<\/jats:italic>\u00a0=\u00a0.039). In a multivariable model, rATG dose, as a continuous variable, remained a significant independent predictor of infection along with CMV risk (OR 1.46, 95% CI 1.02\u20102.09) controlling for age and CMV risk. There were no differences in graft\u2010related outcomes at 180\u00a0days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Higher cumulative rATG induction dose was associated with increased incidence of opportunistic viral infections, in the setting of a steroid\u2010free maintenance immunosuppression in the early post\u2010transplant period.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.14102","type":"journal-article","created":{"date-parts":[[2020,9,28]],"date-time":"2020-09-28T08:21:50Z","timestamp":1601281310000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Antithymocyte induction dosing and incidence of opportunistic viral infections using steroid\u2010free maintenance immunosuppression"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8537-6215","authenticated-orcid":false,"given":"Lauren","family":"Von Stein","sequence":"first","affiliation":[{"name":"Department of Pharmacy The Ohio State University Wexner Medical Center Columbus OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4310-4697","authenticated-orcid":false,"given":"Abbie D.","family":"Leino","sequence":"additional","affiliation":[{"name":"Department of Pharmacy The Ohio State University Wexner Medical Center Columbus OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Todd","family":"Pesavento","sequence":"additional","affiliation":[{"name":"Nephrology, Department of Internal Medicine Ohio State University Columbus OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amer","family":"Rajab","sequence":"additional","affiliation":[{"name":"Division of Transplantation, Department of General Surgery Ohio State University College of Medicine Columbus OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Holli","family":"Winters","sequence":"additional","affiliation":[{"name":"Department of Pharmacy The Ohio State University Wexner Medical Center Columbus OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,12,19]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"901","article-title":"Acute rejection episodes: best predictor of long\u2010term primary cadaveric renal transplant survival","volume":"25","author":"Tesi RJ","year":"1993","journal-title":"Transplant Proc"},{"key":"e_1_2_8_3_1","first-page":"328","article-title":"Acute rejection episodes \u2013 Best predictor of long\u2010term primary cadaveric renal transplant survival","volume":"8","author":"Ferguson RM","year":"1994","journal-title":"Clin Transplant"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2018.01.022"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.04330417"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15342"},{"volume-title":"Thymoglobulin\u00ae (rabbit antithymocyte globulin)","year":"2017","author":"Sanofi Pharmaceuticals Corporation","key":"e_1_2_8_7_1"},{"issue":"3","key":"e_1_2_8_8_1","first-page":"S1","article-title":"KDIGO clinical practice guideline for the care of renal transplant recipients","volume":"9","year":"2009","journal-title":"Am J Transplant"},{"issue":"3","key":"e_1_2_8_9_1","article-title":"The influence of rabbit Antithymocyte Globulin (rATG) dose on the incidence of CMV infection in renal transplant recipients receiving no pharmacological prophylaxis. 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