Current immunosuppressive therapies and protocols have led to significant improvements in early (<1 year) patient and graft survival rates following kidney transplantation. Whether induction therapies such as Thymoglobulin (TGL) contribute to these improved results remains controversial. Full-dose TGL induction therapy (7-10 mg/kg) has been associated with increased morbidity in the early post-transplant period which may be especially true in a high risk population such as the elderly. Therefore, we studied the efficacy and tolerability of a low-dose TGL induction strategy in older recipients (>65 years) (Gr.1, n=45). We compared their post-transplant outcomes to a group of patients less than 65 years old (Group 2, n=45) transplanted during the same period. All patients were transplanted at a single center between Jan. 2001 and Sept. 2007. Both groups received a similar low-dose of TGL induction therapy (Gr.1=2.96 ± 1.29 vs. Gr.2=3.2 ± 2.11 mg/kg). The average age in years for Gr.1 was 73.8 ± 5.4 and for Gr.2, 48 ± 10.7 (p<0.001). The two groups were similar in number of men (66%), African Americans (28%), diabetics (35%), patients with PRA > 30% (6%), CIT (16.1 hrs.), DGF (26%) and living donors (10%). All patients were maintained on a calcineurin inhibitor, mycophenolic acid, and low dose prednisone (5 mg/day). To date, none of the older patients experienced AR whereas 1 younger patient had AR. Initial hospital stays were equal (Gr1 7.8 ± 3.2 vs. Gr.2 7.5± 4.4 days, p=0.35). Within the first 6 months, 9 older patients required re-hospitalization compared to 15 younger patients (p=0.15). Bacterial infections in both groups (Gr.1 vs. Gr 2) were equal including wound (4 vs. 0), urine (20 vs. 15), lung (1 vs. 1) and skin (0 vs. 2). There were 2 BK viral infections in Gr.1. Gr.2 had 3 viral infections, 2 CMV and 1 H. zoster. eGFR at 6 months was equal in both groups (Gr.1 55.7±18.5 vs. Gr.2 52.7±18.5 ml/min). 3-year patient and graft survival rates were equivalent in both groups (Gr1. 86.6% vs. Gr 2. 97.6%). In conclusion, low dose TGL induction therapy is safe and effective in patients >65 years of age. When compared to younger patients, low-dose TGL leads to equivalent graft survival and function without incurring excess morbidity in the older population.
Volume : 6
Issue : 4
Pages : 225
Department of Surgery, State University of New York (SUNY)- at Buffalo, Buffalo, NY, USA