Relation between Adverse Effects and Dose of Anti-Thymocyte Globulin in Kidney or Pancreas Transplantation Patients

Yoo-Jin Uhmo, Eun-Joo Ahn, Hee-Sae Kim, Young-Chun Song and Hye-Sun Gwaka

Department of Pharmacy, Asan Medical Center, College of Pharmacy, Ewha Women's Univ.a

Rabbit-derived anti-thymocyte globulin(rATG) is used for induction therapy, rejection therapy and steroid-withdrawal therapy in organ transplantation. The adverse events of rATG have been reported and the current dose in Asan Medical Center is 50mg as a fixed dose irrespective of patients. Therefore we hypothesized that there is a relationship between adverse effects and dose of rATG. A total of 119 patients given kidney or pancreas transplantation from 2004 to 2010 were studied by the retrospective method. All of patients were medicated at least one of calcineurin inhibitor, antimetabolite, steroid. The commonest adverse events were leukopenia(77.3%), anemia(36.1%), and thrombocytopenia(71.4%); 8.7%, 28.3%, 78.8% of each events, respectively, had each symptom before. 19.3% of patients experienced acute rejection. In hematologic adverse events, dose of rATG was significantly associated to progression of effects, except thrombocytopenia. The incidence of leukopenia was increased with more than 2.91mg/kg as cumulative dose (HR 5.000 CI 1.239-20.181 p=0.024) or 0.70mg/kg/dose (HR 3.469 CI 1.055-11.409 p=0.041). Anemia was also frequently revealed with more than 3.70mg/kg as cumulative dose (HR 2.474 CI 1.003-6.102 p=0.049) or 0.75mg/kg/dose (HR 3.094 CI 1.071-8.944 p=0.037). In other events such as fever, there was no relationship with dosage. The results from this study suggest that hematologic adverse effects induced by rATG depend on dose. Further studies are suggested with larger populations for definite standard of rATG dosage protocol.

주제어 : Anti-thymocyte globulin, ATG, Adverse effects, Dose, Leukopenia, Anemia, Thrombocytopenia, Kidney, Pancreas, Transplantation