Single‐dose rATG induction at renal transplantation: superior renal function and glucoregulation with less hypomagnesemia

Stevens RB, Lane JT, Boerner BP, Miles CD, Rigley TH, Sandoz JP, Nielsen KJ, Skorupa JY, Skorupa AJ, Kaplan B, Wrenshall LE. Single‐dose rATG induction at renal transplantation: superior renal function and glucoregulation with less hypomagnesemia. 
Clin Transplant 2012: 26: 123–132. 
© 2011 John Wiley & Sons A/S. Abstract:  Background:  Rabbit anti‐thymocyte globulin (rATG) induction reduces reperfusion injury and improves renal function in kidney recipients by means of properties unrelated to T‐cell lysis. Here, we analyze intensive rATG induction (single dose, rATG S , vs. divided dose, rATG D ) for improved renal function and protection against hyperglycemia. Methods:  Patients without diabetes (n = 98 of 180) in a prospective randomized trial of intensive rATG induction were followed for six months for the major secondary composite end point of impaired glucose regulation (hyperglycemia and new‐onset diabetes after transplantation, NODAT). Prospectively collected data included fasting blood glucose and HbA 1c . Serum Mg ++ was routinely collected and retrospectively analyzed. Results:  Induction with rATG S produced less impaired glucose regulation (p = 0.05), delayed NODAT development (p = 0.02), less hyperglycemia (p = 0.02), better renal function (p = 0.04), and less hypomagnesemia (p = 0.02), a factor associated with a lower incidence of NODAT. Generalized linear modeling confirmed that rATG S protects against a synergistic interaction between tacrolimus and sirolimus that otherwise increased hypomagnesemia (p = 0.008) and hyperglycemia (p = 0.03). Conclusions:  rATG S initiated before renal reperfusion improved early renal function and reduced impaired glucose regulation, an injury by diabetogenic maintenance agents (tacrolimus and sirolimus).