title: Monitoring of CD3(+) T-cell count in patients receiving antithymocyte globulin induction after cadaveric renal transplantation.
abstract: OBJECTIVE
  Although antithymocyte globulin (ATG) has been used for years, its ideal dose and administration period is obscure. Herein, we sought to use the CD3(+) cell count to detect the optimal ATG dosage.
  
  
  METHODS
  Twenty-one patients who underwent cadaveric donor renal transplantation from January 2009 to January 2012 received a 1 mg/kg ATG initial dose at the time of the operation. Patients were randomized into 2 cohorts. Group 1 (n = 11) received ATG according to the clinical and total lymphocyte count and group 2 (n = 10), the dose was tailored according to the CD3(+) cell count. We compared the total and daily ATG dosages, ATG administration period, side effects of ATG, the number of days to a serum creatinine level <2 mg/dL, graft function at 3 months, acute rejection episodes, infection rates, costs of CD3(+) analysis, and ATG amounts.
  
  
  RESULTS
  Both groups showed similar gender, age, and human leukocyte antigen matching data. There was no difference in presensitizing events or panel-reactive antibody class 1 and 2 levels. The number of days to a serum creatinine level of <2 mg/dL was 11 ± 1.5 for group 1 versus 10.4 ± 0.8 for group 2 (P = .45). Between groups 1 and 2, there was a significant difference between the mean total (P = .031) and mean daily ATG dosages (P = .006). We used a total dose of 3800 mg ATG for group 1 and 2200 mg for group 2 and for the group 2 who underwent 43 CD3(+) cell counts. The expenditure per patient was 20% higher among group 1 than group 2.
  
  
  CONCLUSIONS
  Determination of appropriate ATG dosages by CD3(+) cell counts was useful, reliable, and cost effective.
authors.affiliation: Department of Transplantation and 1st General Surgery, Haydarpasa Numune Hospital, Istanbul, Turkey. pinaren@gmail.com
authors.forename: P
authors.initials: P
authors.lastname: Ata
authors.forename: M
authors.initials: M
authors.lastname: Kara
authors.forename: E
authors.initials: E
authors.lastname: Özdemir
authors.forename: M
authors.initials: M
authors.lastname: Canbakan
authors.forename: A M
authors.initials: AM
authors.lastname: Gökçe
authors.forename: F A
authors.initials: FA
authors.lastname: Bayraktar
authors.forename: G
authors.initials: G
authors.lastname: Şahin
authors.forename: L
authors.initials: L
authors.lastname: Özel
authors.forename: M I
authors.initials: MI
authors.lastname: Titiz
mesh_terms: D000328:Adult; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D017252:CD3 Complex / Q000276:immunology*; D002102:Cadaver; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D013601:T-Lymphocytes / Q000276:immunology*
chemical_list: D000961:Antilymphocyte Serum; D017252:CD3 Complex