{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T01:25:35Z","timestamp":1787189135869,"version":"build-2736575974"},"reference-count":30,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nephrology"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Rabbit anti\u2010thymocyte globulin (rATG) is widely used for induction immunosuppression in kidney transplantation, but conventional dosing is largely weight based and may not reflect dynamic interindividual immune responses. We aimed to evaluate a predefined, individualized dosing strategy guided by peripheral CD4\u2010to\u2010total lymphocyte (CD4\/TLC) and CD8\u2010to\u2010total lymphocyte (CD8\/TLC) ratios and to assess its feasibility and 1\u2010year outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this single\u2010center retrospective cohort study conducted in Taiwan from 2018 to 2024, 76 adult kidney transplant recipients received rATG titrated by serial flow cytometry to a predefined target of both CD4\/TLC and CD8\/TLC ratios &lt;\u200910%. We evaluated cumulative rATG exposure, lymphocyte\u2010subset response, for\u2010cause biopsy\u2010proven acute rejection (BPAR), graft function, graft loss, hospitalization\u2010requiring infections, and mortality over 1\u2009year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median cumulative rATG dose was 1.2\u2009mg\/kg (IQR, 1.1\u20131.5; maximum, 3.8). Thirty\u2010eight recipients (50.0%) reached the immunologic target after a single intraoperative dose (1\u20131.5\u2009mg\/kg). At 1\u2009year, for\u2010cause BPAR occurred in 1 recipient (1.3%), mean serum creatinine was 1.20\u2009mg\/dL, and no graft loss occurred. Seventeen recipients experienced hospitalization\u2010requiring infections, accounting for 22 episodes. No CMV disease or biopsy\u2010proven BK virus nephropathy was observed. Four recipients (5.3%) died, including two deaths related to opportunistic fungal infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CD4\/TLC\u2010 and CD8\/TLC\u2010guided rATG dosing was feasible and achieved predefined immunologic targets with low cumulative rATG exposure in this cohort. These findings support prospective controlled studies to evaluate the clinical utility, safety, and comparative effectiveness of this individualized dosing strategy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nep.70267","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T04:51:48Z","timestamp":1786423908000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<scp>CD4\u2010<\/scp>\n                    and\n                    <scp>CD8<\/scp>\n                    \u2010to\u2010Total Lymphocyte Ratios to Guide Rabbit Anti\u2010Thymocyte Globulin Induction in Kidney Transplant Recipients: A Single\u2010Center Feasibility Study"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7424-0352","authenticated-orcid":false,"given":"I\u2010Ru","family":"Chen","sequence":"first","affiliation":[{"name":"Division of Nephrology and the Kidney Institute, Department of Internal Medicine China Medical University Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9131-2936","authenticated-orcid":false,"given":"Ping\u2010Chin","family":"Lai","sequence":"additional","affiliation":[{"name":"Division of Nephrology and the Kidney Institute, Department of Internal Medicine China Medical University Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiu\u2010Ching","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Nephrology and the Kidney Institute, Department of Internal Medicine China Medical University Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9225-7334","authenticated-orcid":false,"given":"Huey\u2010Liang","family":"Kuo","sequence":"additional","affiliation":[{"name":"Division of Nephrology and the Kidney Institute, Department of Internal Medicine China Medical University Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang\u2010Cheng","family":"Jiang","sequence":"additional","affiliation":[{"name":"Division of Nephrology and the Kidney Institute, Department of Internal Medicine China Medical University Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia\u2010Hui","family":"Chou","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine China Medical University Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao\u2010Hsiang","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Urology China Medical University Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi\u2010Ping","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Urology China Medical University Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chin\u2010Chung","family":"Yeh","sequence":"additional","affiliation":[{"name":"Department of Urology China Medical University Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0989-7876","authenticated-orcid":false,"given":"Po\u2010Jen","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Department of Urology China Medical University Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guan\u2010Heng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Urology China Medical University Hsinchu Hospital  Hsinchu Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu\u2010Cyuan","family":"Hong","sequence":"additional","affiliation":[{"name":"Division of Nephrology and the Kidney Institute, Department of Internal Medicine China Medical University Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi\u2010Huei","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Urology China Medical University Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"issue":"3","key":"e_1_2_11_2_1","first-page":"S1","article-title":"KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients","volume":"9","author":"Kasiske B. 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