The Authors’ Reply : Transplantation

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The Authors’ Reply

Locke, Jayme E.1; Segev, Dorry L.2

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Transplantation 97(12):p e70-e71, June 27, 2014. | DOI: 10.1097/TP.0000000000000193
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We appreciate both the kind words and concerns of Nazarian and colleagues. The authors raised the possibility that lower-risk patients might have received antithymocyte globulin (ATG) induction therapy. We find this highly unlikely, because ATG is usually reserved for higher immunologic risk rather than lower immunologic risk patients, and as evidenced by baseline demographics that demonstrated ATG-induced human immunodeficiency virus (HIV)-infected recipients were more often African American and sensitized compared to their HIV-negative counterparts. Further, we also point out that the analyses that led to our inferences were adjusted for multiple recipient and donor factors known to affect long-term outcomes.

The authors also raise the limitations of relatively short-term follow-up and lack of outcomes beyond graft and patient survival. We too lament these limitations of the currently available SRTR data, as we discussed in our article.

Finally, although randomized controlled trials are indeed the highest level of evidence, we are skeptical of the feasibility of achieving, for the trial proposed by the authors, an adequate sample size in the current environment of HIV+ kidney transplantation. Even if possible, such a trial would likely take 5 to 10 years. In the interim, we believe that it is critically important to continue studying and adapting clinical practice based on studies of observational data.

Jayme E. Locke

1

Dorry L. Segev2

1 University of Alabama at Birmingham

Comprehensive Transplant Institute

Birmingham, AL

2 Johns Hopkins University

Comprehensive Transplant Center

Baltimore, MD

© 2014 by Lippincott Williams & Wilkins