title: Single-dose rATG induction at renal transplantation: superior renal function and glucoregulation with less hypomagnesemia.
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).
authors.affiliation: Departments of Surgery, University of Nebraska Medical Center, Omaha, NE 68198-3285, USA. rbstevens@unmc.edu
authors.forename: R Brian
authors.initials: RB
authors.lastname: Stevens
authors.forename: James T
authors.initials: JT
authors.lastname: Lane
authors.forename: Brian P
authors.initials: BP
authors.lastname: Boerner
authors.forename: Clifford D
authors.initials: CD
authors.lastname: Miles
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Rigley
authors.forename: John P
authors.initials: JP
authors.lastname: Sandoz
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Nielsen
authors.forename: Jill Y
authors.initials: JY
authors.lastname: Skorupa
authors.forename: Anna J
authors.initials: AJ
authors.lastname: Skorupa
authors.forename: Bruce
authors.initials: B
authors.lastname: Kaplan
authors.forename: Lucile E
authors.initials: LE
authors.lastname: Wrenshall
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D001786:Blood Glucose / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000517:prevention & control*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011817:Rabbits; D015499:Renal Tubular Transport, Inborn Errors / Q000209:etiology / Q000517:prevention & control*; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum; D001786:Blood Glucose; D007166:Immunosuppressive Agents