Significant improvements in patient and graft outcomes following kidney transplantation have been made over the past decade. However, the role of induction therapy in these advances remains uncertain. Moreover, the type of induction therapy, whether lymphocyte depleting therapies such as Thymoglobulin (TGL) or non-depleting agents such as anti-IL2R antibodies, is also controversial. In the recent reports, full dose TGL (7-10 mg/kg) was associated with higher rates of infection and cancer compared to anti-IL2R antibody induction. In this retrospective study, we compare the efficacy and safety of a lower dose TGL induction therapy (3-5mg/kg total dose, mean dose = 3.64 mg/kg) to Simulect (SM) (20mg given 4 d apart) induction therapy. Between 2000 and 2007, 355 kidney transplant recipients received TGL and 93 patients received SM for induction. Both groups received equal triple immunosuppression therapy consisting of a calcineurin inhibitor, MMF and low-dose prednisone. Demographic data including sex, donor type, age, race, HTN, DM, PRA> 30% and HLA matching was similar in both groups. Mean CIT was longer in TGL group (15+9 vs. 13+9 hours, p=0.04). Both groups had equal hospital stays (TGL 8.3 vs. SM 7.6 days, p= 0.44) and delayed graft function (TGL 28% vs. SM 26%, p= 0.49). Over the past 7 years, 43 patients in the TGL group and 14 patients in the SM group died (p=0.44). Of the 43 deaths in the TGL group, 6 died from infection/sepsis compared to 1 in the SM group (p= 0. 67). All deaths due to infection occurred after 4 months post-transplant and 80% occurred after 2 years. Acute graft rejection occurred in 11% and 13% in TGL and SM group respectively (p=0.6). Graft lost (death censored) occurred in 43 pts in TGL group compared to 9 pts who received SM (p=0.51). In conclusion, low dose TGL and SM were equally effective in promoting graft survival and preventing acute rejection. There was no increased risk of death, infection or cancer in the low-dose TGL group.
Volume : 6
Issue : 4
Pages : 3
Department of Surgery, SUNY-University at Buffalo, Buffalo General Hospital, Buffalo, NY, USA.