Current Induction Therapy Strategies and Anti-T Lymphocyte Globulin Usage in Kidney Transplantation: Consensus-Based Recommendations by a Turkish Expert Panel

Abstract

This advisory committee convened to review national and global kidney transplantation dynamics and provide recom- mendations on the use of anti-T lymphocyte globulin (ATLG) for prevention and treatment of rejection after allogeneic kidney transplantation. A critical evaluation of 6 relevant articles released up to October 2022 was performed to reveal their importance in clinical practice. Additionally, 27 key questions on the indication, dosage of ATLG, and risk stratification were used for the Delphi technique with 8 members of the Turkish Society of Nephrology including 5 kidney transplanta- tion (KTx) subcommittee members and a surgeon experienced in solid organ transplantation. The committee declared that Türkiye had great potential in KTx; however, increase in transplantation would be possible in the case of raise in the deceased donor transplantation. As a consensus, ATLG was strongly recommended for induction and rejection treatment. Also, committee members recommended the safe dosage range in steroid resistant acute rejection as 2.5-3 mg/kg daily for 5-7 days, and the median of preferred dosage in induction sounded as 2-2.5 mg/kg daily for 3 days in intermediate risk state. Additionally, post-transplant infection and malignancy cases due to immunosuppression were much rarely encoun- tered than they were in the past.