We report our experience in using 2 different Rabbit Antithymocyte Globulin (RAG) as induction agents in high risk renal transplant recipients: ATG (Fresenius, Germany) and Thymoglobulin (Sangstat, Fremont, CA). Fourteen patients in group A received Thymoglobulin at 1.5mg/kg/dose and 30 patients in group B received ATG at 4mg/kg/dose for 5-10 days. The two groups were comparable for recipient, donor characteristics and maintenance immunosuppression. However, five patients in group A (35.7%) were highly sensitized compared to 3 patients (10%) in groups B.
After a median follow-up of 180 days, patients and grafts survival were not different between the two groups (100% vs 100%) and (96% vs 92%); p= NS. One episode of Banff 1A rejection in group A was reported compared to (7%) and 8 episodes (26.7%) of acute rejection episodes in group; (p=0.97). Two rejection episodes in group B were steroid resistant. Serum creatinin was not different after 3 months, 107 vs 108 µmol/L (p=0.93). Infectious complications were comparable between the two groups; (p=0.4). Despite the inclusion of more high risk recipients in group A, the use of Thymoglobulin as an induction agent was associated with fewer and less severe rejection episodes when compared to ATG