Induction Therapy in Kidney Transplantation - Summary
Most kidney transplant centers in the United States utilize induction agents as part of their immunosupression protocols. The reasoning behind is that induction therapy has been shown to reduce the rate of acute rejection, however no trial has yet demonstrated an improvement in long-term graft survival. Induction therapy has also expanded in centers using steroid-withdrawal protocols and in patients with expected delayed graft function due to prolong ischemia time (ECD/DCD kidneys), since calcineurin inhibitor initiation may be delayed (significant vasoconstriction from CNI may potentially delay recovery).
Rabbit antithymocyte globulin (rATG or Thymoglobulin) is the most common agent used in more than 55% of transplant cases in the USA, despite not being FDA-approved for this use (only for treatment of severe cellular rejection). Curiously, rATG is prepared by immunizing pathogen-free
Our center uses ATG for induction in high immunological risk patients and Basiliximab for low risk patients in combination with tacrolimus and MMF for maintenance. Steroid withdrawal is performed on most patients by the end of first week post-transplantation, with the exception of highly sensitized patients.
Below a summary table of the 3 most common induction agents in clinical use today, their target cells, dose, cost and side effects.
Antibody | Brand | Class | Lymphocyte depleting | Antigenic Target and Cells | Typical prescription | Side effects |
Basiliximab | Simulect (Novartis) | Monoclonal | No | IL2 receptor (CD25) Activated T cells |
20mg x2 doses U$4,254 | Hypersensitivity reaction (rare) |
Rabbit antithymocyte globulin | Thymoglobulin (Genzyme) | Polyclonal | Yes | Multiple Ag Mainly T cells, to a lesser extent B and NK cells |
1.5mg/kg 3-7 doses U$7,824-18,256 Premedicate with steroids and Tylenol Decrease dose if WBC<3 or=”" ptls=”" span=”"> |
Fever, chills, dyspnea, nausea, diarrhea, headache, general pain and pulmonary edema (cytokine release syndrome) |
Alemtuzumab | Campath 1H (Berlex Laboratories) | Monoclonal | Yes (more prolonged) | CD52 Ag T, B and NK cells, monocytes, macrophages, dendritic cells, eosinophils, mast cells |
30mg x1 dose U$2,065 | Generally none when given subcutaneously |
Source: http://renalfellow.blogspot.com/2013/10/induction-therapy-in-kidney.html
Anyone can join.
Anyone can contribute.
Anyone can become informed about their world.
"United We Stand" Click Here To Create Your Personal Citizen Journalist Account Today, Be Sure To Invite Your Friends.
Humic & Fulvic Liquid Trace Mineral Complex
HerbAnomic’s Humic and Fulvic Liquid Trace Mineral Complex is a revolutionary New Humic and Fulvic Acid Complex designed to support your body at the cellular level. Our product has been thoroughly tested by an ISO/IEC Certified Lab for toxins and Heavy metals as well as for trace mineral content. We KNOW we have NO lead, arsenic, mercury, aluminum etc. in our Formula. This Humic & Fulvic Liquid Trace Mineral complex has high trace levels of naturally occurring Humic and Fulvic Acids as well as high trace levels of Zinc, Iron, Magnesium, Molybdenum, Potassium and more. There is a wide range of up to 70 trace minerals which occur naturally in our Complex at varying levels. We Choose to list the 8 substances which occur in higher trace levels on our supplement panel. We don’t claim a high number of minerals as other Humic and Fulvic Supplements do and leave you to guess which elements you’ll be getting. Order Your Humic Fulvic for Your Family by Clicking on this Link , or the Banner Below.
Our Formula is an exceptional value compared to other Humic Fulvic Minerals because...
It’s OXYGENATED
It Always Tests at 9.5+ pH
Preservative and Chemical Free
Allergen Free
Comes From a Pure, Unpolluted, Organic Source
Is an Excellent Source for Trace Minerals
Is From Whole, Prehisoric Plant Based Origin Material With Ionic Minerals and Constituents
Highly Conductive/Full of Extra Electrons
Is a Full Spectrum Complex
Our Humic and Fulvic Liquid Trace Mineral Complex has Minerals, Amino Acids, Poly Electrolytes, Phytochemicals, Polyphenols, Bioflavonoids and Trace Vitamins included with the Humic and Fulvic Acid. Our Source material is high in these constituents, where other manufacturers use inferior materials.
Try Our Humic and Fulvic Liquid Trace Mineral Complex today. Order Yours Today by Following This Link.
![Report abuse](/img/report_abuse.png)