{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T05:27:57Z","timestamp":1767677277384,"version":"3.37.3"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T00:00:00Z","timestamp":1677628800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008976","name":"Sanofi-Aventis Korea Company","doi-asserted-by":"publisher","award":["THYMOL07047"],"award-info":[{"award-number":["THYMOL07047"]}],"id":[{"id":"10.13039\/100008976","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The optimal dose of anti-thymocyte globulin (ATG) as an induction regimen in Asian living-donor kidney recipients is unclear.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This is a pilot study in which 36 consecutive patients undergoing living-donor kidney transplantation were randomly assigned to receive either 4.5 mg\/kg (n = 19) or 6.0 mg\/kg (n = 17) of ATG; all patients had corticosteroid withdrawal within 7 days. The primary end point was a composite of biopsy-proven acute rejection, <jats:italic>de novo<\/jats:italic> donor-specific antibody formation, and graft failure.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>At 12 months post-transplant, biopsy-proven acute rejection was more common in the ATG4.5 group (21.1%) than in the ATG6.0 group (0%)(<jats:italic>P<\/jats:italic> = .048). Importantly, the rate of the composite end point was significantly higher in the ATG4.5 group (36.8% vs 0%)(<jats:italic>P<\/jats:italic> = .006). There were significant differences in neither the renal function nor adverse events between the two groups. One case of death-censored graft failure occurred in the ATG4.5 group and no mortality was observed overall. Compared with pre-transplantation, T cells, natural killer (NK) cells, and natural killer T (NKT) cells were significantly decreased in the first week post-transplantation except for B cells. Although T and NKT cells in both groups and NK cells in the ATG4.5 group had recovered to the pre-transplant levels, NK cells in the ATG6.0 group remained suppressed until six months post-transplant.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Compared with ATG 6.0 mg\/kg, ATG 4.5 mg\/kg with early corticosteroid withdrawal and low dose maintenance regimen was associated with higher rates of acute rejection in non-sensitized Asian living-donor kidney recipients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Trial registration<\/jats:title>\n<jats:p>ClinicalTrials.gov: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02447822?term=NCT02447822&amp;draw=2&amp;rank=1\" xlink:type=\"simple\">NCT02447822<\/jats:ext-link>.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0280924","type":"journal-article","created":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T18:32:27Z","timestamp":1677695547000},"page":"e0280924","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["A prospective, randomized, non-blinded, non-inferiority pilot study to assess the effect of low-dose anti-thymocyte globulin with low-dose tacrolimus and early steroid withdrawal on clinical outcomes in non-sensitized living-donor kidney recipients"],"prefix":"10.1371","volume":"18","author":[{"given":"Youngmin","family":"Ko","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Mee","family":"Wee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1894-1381","authenticated-orcid":true,"given":"Sung","family":"Shin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mi Joung","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica Young","family":"Choi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dong Hyun","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seong Jun","family":"Lim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joo Hee","family":"Jung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyunwook","family":"Kwon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young Hoon","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Duck Jong","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,3,1]]},"reference":[{"key":"pone.0280924.ref001","doi-asserted-by":"crossref","first-page":"e104408","DOI":"10.1371\/journal.pone.0104408","article-title":"Immunophenotyping and efficacy of low dose ATG in non-sensitized kidney recipients undergoing early steroid withdrawal: a randomized pilot study.","volume":"9","author":"M. Grafals","year":"2014","journal-title":"PLoS One"},{"key":"pone.0280924.ref002","doi-asserted-by":"crossref","first-page":"2715","DOI":"10.1056\/NEJMra033540","article-title":"Immunosuppressive drugs for kidney transplantation","volume":"351","author":"P. F. Halloran","year":"2004","journal-title":"New England Journal of Medicine"},{"key":"pone.0280924.ref003","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1097\/01.tp.0000234905.56926.7f","article-title":"Induction immunosuppression.","volume":"82","author":"A. D. Kirk","year":"2006","journal-title":"Transplantation"},{"key":"pone.0280924.ref004","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1159\/000351643","article-title":"Thymoglobulin and its use in renal transplantation: a review.","volume":"37","author":"U. M. Thiyagarajan","year":"2013","journal-title":"American journal of nephrology"},{"key":"pone.0280924.ref005","doi-asserted-by":"crossref","first-page":"1832","DOI":"10.1016\/j.intimp.2011.07.012","article-title":"Induction antibody therapy in renal transplantation using early steroid withdrawal: long-term results comparing anti-IL2 receptor and anti-thymocyte globulin","volume":"11","author":"A. B. Lib\u00f3rio","year":"2011","journal-title":"International immunopharmacology"},{"key":"pone.0280924.ref006","doi-asserted-by":"crossref","first-page":"1967","DOI":"10.1056\/NEJMoa060068","article-title":"Rabbit antithymocyte globulin versus basiliximab in renal transplantation","volume":"355","author":"D. C. 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