{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T22:29:17Z","timestamp":1762295357252,"version":"3.41.2"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T00:00:00Z","timestamp":1669852800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>In sensitized deceased donor kidney allograft recipients, the most frequent induction therapy is anti-thymocyte globulins (ATG), including Thymoglobulin\u00ae (Thymo) and ATG-Fresenius (ATG-F).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a 3-year monocentric observational study to compare the impact of ATGs on hematological parameters. We included adult kidney transplant recipients treated with ATG induction therapy, either Thymo or ATG-F, on a one-in-two basis. The primary endpoint was red blood cell (RBC) transfusions within 14 days after transplantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 309 kidney allograft recipients, 177 (57.2%) received ATG induction, 90 (50.8 %) ATG-F, and 87 (49.2%) Thymo. The ATG-F group received significantly more RBC transfusions (63.3% vs. 46% p = 0.02) and in bigger volumes (p = 0.01). Platelet transfusion was similar in both groups. Within 14 and 30 days after transplantation, older age, ATG-F induction, and early surgical complication were independently associated with RBC transfusion. Patient survival rate was 95%, and the death-censored kidney allograft survival rate was 91.5% at 12 months post-transplantation. There was no difference in the incidence of acute rejection and infections or in the prevalence of anti-HLA donor-specific antibodies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>In conclusion, after kidney transplantation, ATG-F is an independent risk factor for early RBC transfusion and early thrombocytopenia without clinical and biological consequences. These new data should be clinically considered, and alternatives to ATG should be further explored.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2022.1045580","type":"journal-article","created":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T19:30:11Z","timestamp":1669923011000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["ATG-Fresenius increases the risk of red blood cell transfusion after kidney transplantation"],"prefix":"10.3389","volume":"13","author":[{"given":"Maria","family":"Sebti","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camille","family":"Petit-Hoang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Btissam","family":"Chami","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c9tienne","family":"Audureau","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Cordonnier-Jourdin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muriel","family":"Paul","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franck","family":"Pourcine","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe","family":"Grimbert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cl\u00e9ment","family":"Ourghanlian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie","family":"Matignon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,12,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199912023412303","article-title":"Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant","volume":"341","author":"Wolfe","year":"1999","journal-title":"N Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2014530","article-title":"Long-term survival after kidney transplantation","volume":"385","author":"Hariharan","year":"2021","journal-title":"N Engl J Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.03800415","article-title":"Induction therapy in renal transplantation: Why? what agent? what dose? we may never know","volume":"10","author":"Wiseman","year":"2015","journal-title":"CJASN"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15342","article-title":"Rabbit anti-thymocyte globulin for the prevention of acute rejection in kidney transplantation","volume":"19","author":"Alloway","year":"2019","journal-title":"Am J Transplant"},{"key":"B5","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1186\/s41100-018-0186-3","article-title":"Current status and future aspects of kidney transplantation in Japan","volume":"4","author":"Aikawa","year":"2018","journal-title":"Ren Replace Ther"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1038\/sj.leu.2404683","article-title":"Mechanisms of action of antithymocyte globulin: T-cell depletion and beyond","volume":"21","author":"Mohty","year":"2007","journal-title":"Leukemia"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfw368","article-title":"Anti-thymocyte globulins in kidney transplantation: Focus on current indications and long-term immunological side effects","volume":"32","author":"Bamoulid","year":"2017","journal-title":"Nephrol Dialysis Transplant"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.00457","article-title":"Thymoglobulin vs. ATG-fresenius as induction therapy in kidney transplantation: A Bayesian network meta-analysis of randomized controlled trials","volume":"11","author":"Song","year":"2020","journal-title":"Front Immunol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.13680","article-title":"Effectiveness and safety of two different antithymocyte globulins used in induction therapy in kidney transplant recipients: A single-center experience","volume":"33","author":"Styrc","year":"2019","journal-title":"Clin Transplant"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0165233","article-title":"A comparison of two types of rabbit antithymocyte globulin induction therapy in immunological high-risk kidney recipients: A prospective randomized control study","volume":"11","author":"Burkhalter","year":"2016","journal-title":"PLoS One"},{"key":"B11","doi-asserted-by":"publisher","first-page":"ii33","DOI":"10.1093\/ndt\/gfh1080","article-title":"Secondary effects of immunosuppressive drugs after simultaneous pancreas-kidney transplantation","volume":"20","author":"Kuypers","year":"2005","journal-title":"Nephrol Dial Transplant"},{"key":"B12","article-title":"Hematologic adverse effects of 2 different polyclonal antilymphocyte preparations in de novo kidney transplant patients","volume":"8","author":"Rostaing","year":"2010","journal-title":"Exp Clin Transplant"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2020.09.014","article-title":"Impact of immunosuppressive strategies on post\u2013kidney transplantation thrombocytopenia","volume":"53","author":"Gierczak","year":"2021","journal-title":"Transplant Proc"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-6143.2003.00133.x","article-title":"Prevalence and management of anemia in renal transplant recipients: A European survey","volume":"3","author":"Vanrenterghem","year":"2003","journal-title":"Am J Transplant"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.13795","article-title":"Impact of early blood transfusion after kidney transplantation on the incidence of donor-specific anti-HLA antibodies","volume":"16","author":"Ferrandiz","year":"2016","journal-title":"Am J Transplant"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1111\/nep.12469","article-title":"Comparison of efficacy and safety between rabbit anti-thymocyte globulin and anti-T lymphocyte globulin in kidney transplantation from donation after cardiac death: A retrospective cohort study","volume":"20","author":"Chen","year":"2015","journal-title":"Nephrol (Carlton)"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.6002\/ect.2013.0027","article-title":"Clinical experience with thymoglobulin and antithymocyte globulin-fresenius as induction therapy in renal transplant patients: a retrospective study","volume":"11","author":"Cicora","year":"2013","journal-title":"Exp Clin Transplant"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-200211150-00014","article-title":"Donor characteristics associated with reduced graft survival: An approach to expanding the pool of kidney donors","volume":"74","author":"Port","year":"2002","journal-title":"Transplantation"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann Intern Med"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1159\/000491558","article-title":"Delayed graft function: The AKI of kidney transplantation","volume":"140","author":"Mannon","year":"2018","journal-title":"Nephron"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15898","article-title":"The banff 2019 kidney meeting report (I): Updates on and clarification of criteria for T cell\u2013 and antibody-mediated rejection","volume":"20","author":"Loupy","year":"2020","journal-title":"Am J Transplant"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.9185","article-title":"Clinical practice guidelines from the AABB: Red blood cell transfusion thresholds and storage","volume":"316","author":"Carson","year":"2016","journal-title":"JAMA"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1111\/trf.12943","article-title":"Platelet transfusion: A systematic review of the clinical evidence","volume":"55","author":"Kumar","year":"2015","journal-title":"Transfusion"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.13795","article-title":"Impact of early blood transfusion after kidney transplantation on the incidence of donor-specific anti-HLA antibodies","volume":"16","author":"Ferrandiz","year":"2016","journal-title":"Am J Transplant"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.trim.2013.09.008","article-title":"Peri-operative third party red blood cell transfusion in renal transplantation and the risk of antibody-mediated rejection and graft loss","volume":"29","author":"Fidler","year":"2013","journal-title":"Transpl Immunol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2021.01.015","article-title":"Blood transfusion and adverse graft-related events in kidney transplant patients","volume":"6","author":"Massicotte-Azarniouch","year":"2021","journal-title":"Kidney Int Rep"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.852079","article-title":"Early blood transfusion after kidney transplantation does not lead to dnDSA development: The BloodIm study","volume":"13","author":"Jouve","year":"2022","journal-title":"Front Immunol"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1517\/14712598.2013.822064","article-title":"A review on comparing two commonly used rabbit anti-thymocyte globulins as induction therapy in solid organ transplantation","volume":"13","author":"Gharekhani","year":"2013","journal-title":"Expert Opin Biol Ther"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2005.05.022","article-title":"Immunosuppressive drugs after simultaneous pancreas-kidney transplantation","volume":"37","author":"Malaise","year":"2005","journal-title":"Transplant Proc"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1007\/s00147-002-0418-9","article-title":"A prospective randomized controlled study on the efficacy and tolerance of two antilymphocytic globulins in the prevention of rejection in first-heart transplant recipients","volume":"15","author":"Schnetzler","year":"2002","journal-title":"Transpl Int"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.13316","article-title":"Mechanism of platelet activation and hypercoagulability by antithymocyte globulins (ATG)","volume":"15","author":"Cumpelik","year":"2015","journal-title":"Am J Transplant"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002357","article-title":"Toward a sensible single-antigen bead cutoff based on kidney graft survival","volume":"103","author":"Wisse","year":"2019","journal-title":"Transplantation"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfl042","article-title":"Major effects of delayed graft function and cold ischaemia time on renal allograft survival","volume":"21","author":"Quiroga","year":"2006","journal-title":"Nephrol Dialysis Transplant"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2022.1045580\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T19:30:13Z","timestamp":1669923013000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2022.1045580\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,1]]},"references-count":33,"alternative-id":["10.3389\/fimmu.2022.1045580"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2022.1045580","relation":{},"ISSN":["1664-3224"],"issn-type":[{"type":"electronic","value":"1664-3224"}],"subject":[],"published":{"date-parts":[[2022,12,1]]},"article-number":"1045580"}}