Graft Pre-conditioning by Peri-Operative Perfusion of Kidney Allografts With Rabbit Anti-human T-lymphocyte Globulin Results in Improved Kidney Graft Function in the Early Post-transplantation Period—a Prospective, Randomized Placebo-Controlled Trial

• Published in: Frontiers in immunology Vol. 9; p. 1911
• Main Authors: Ritschl, Paul V., Günther, Julia, Hofhansel, Lena, Kühl, Anja A., Sattler, Arne, Ernst, Stefanie, Friedersdorff, Frank, Ebner, Susanne, Weiss, Sascha, Bösmüller, Claudia, Weissenbacher, Annemarie, Oberhuber, Rupert, Cardini, Benno, Öllinger, Robert, Schneeberger, Stefan, Biebl, Matthias, Denecke, Christian, Margreiter, Christian, Resch, Thomas, Aigner, Felix, Maglione, Manuel, Pratschke, Johann, Kotsch, Katja
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 24.08.2018
• Subjects: ATLG; Immunology; ischemia reperfusion injury; kidney transplantation; organ preservation; RCT; ATLG; RCT; ischemia reperfusion injury; kidney transplantation; organ preservation
• ISSN: 1664-3224; 1664-3224
• DOI: 10.3389/fimmu.2018.01911

Although prone to a higher degree of ischemia reperfusion injury (IRI), the use of extended criteria donor (ECD) organs has become reality in transplantation. We therefore postulated that peri-operative perfusion of renal transplants with anti-human T-lymphocyte globulin (ATLG) ameliorates IRI and results in improved graft function. We performed a randomized, single-blinded, placebo-controlled trial involving 50 kidneys (KTx). Prior to implantation organs were perfused and incubated with ATLG (AP) ( = 24 kidney). Control organs (CP) were perfused with saline only ( = 26 kidney). Primary endpoint was defined as graft function reflected by serum creatinine at day 7 post transplantation (post-tx). AP-KTx recipients illustrated significantly better graft function at day 7 post-tx as reflected by lower creatinine levels, whereas no treatment effect was observed after 12 months surveillance. During the early hospitalization phase, 16 of the 26 CP-KTx patients required dialysis during the first 7 days post-tx, whereas only 10 of the 24 AP-KTx patients underwent dialysis. No treatment-specific differences were detected for various lymphocytes subsets in the peripheral blood of patients. Additionally, mRNA analysis of 0-h biopsies post incubation with ATLG revealed no changes of intragraft inflammatory expression patterns between AP and CP organs. We here present the first clinical study on peri-operative organ perfusion with ATLG illustrating improved graft function in the early period post kidney transplantation. www.ClinicalTrials.gov, NCT03377283.