Anti-thymocyte globulin versus basiliximab induction in renal transplant recipients: Long-term outcome

• Published in: Saudi journal of kidney diseases and transplantation 2014-01, Vol.25 (1), p.9-15
• Main Authors: Kesiraju, Sailaja, Paritala, Purna, Rao Ch, Uma Maheswara, Athmakuri, Srinivasa Murthy, Reddy, V S, Sahariah, S
• Format: Article
• Language: English
• Subjects: Adult; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal - therapeutic use; Antilymphocyte Serum - adverse effects; Antilymphocyte Serum - therapeutic use; Antithymocyte globulin; Basiliximab; Biomarkers - blood; Blood; Blood platelets; Causes of; Creatinine - blood; Cytomegalovirus; Cytomegalovirus infections; Cytomegalovirus Infections - epidemiology; Cytomegalovirus Infections - prevention & control; Drug dosages; Drug therapy; Drug Therapy, Combination; Female; Glomerular Filtration Rate - drug effects; Graft Rejection - immunology; Graft Rejection - mortality; Graft Rejection - prevention & control; Graft Survival - drug effects; Health aspects; Humans; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Incidence; India - epidemiology; Infections; Kaplan-Meier Estimate; Kidney Transplantation - adverse effects; Kidney Transplantation - mortality; Kidneys; Living Donors; Lymphocytes; Male; Middle Aged; Mortality; Patients; Polymerase chain reaction; Recombinant Fusion Proteins - adverse effects; Recombinant Fusion Proteins - therapeutic use; Retrospective Studies; Time Factors; Transplantation; Transplants & implants; Treatment Outcome; Tuberculosis - epidemiology; Tuberculosis - prevention & control
• ISSN: 1319-2442; 2320-3838
• DOI: 10.4103/1319-2442.124459

Although basiliximab and rabbit anti-thymocyte globulin (ATG) are effective in delaying and reducing the incidence of acute rejection (AR) thus improving short-term graft survival, their impact on long-term graft survival has not been well established in renal transplant recipients. To evaluate the long-term efficacy after induction therapy with ATG/basiliximab in renal transplant recipients, we studied retrospectively 86 renal transplant recipients of living donor renal transplantation from 2003 to 2006; of them, 42 patients received induction with ATG three doses of 50 mg, 25 mg, 25 mg/day on 0, 1 and 2 post-operative days (POD) and 44 age-matched patients received induction with basiliximab (20 mg/day on 0 and 4 PODs). All the patients received tacrolimus, mycophenolate mofetil and corticosteroids as maintenance immunosuppressive therapy. Demographic characteristics were similar between both groups. Patient survival at 5 years was 90.5% in the ATG group and 84.1% in the basiliximab group, while graft survival was 83.4% and 77.3%, respectively. The incidence of acute rejection was 14.2% and 18.1% in the ATG and the basiliximab groups, respectively. The estimated mean glomerular filtration rates at 5 years post-transplantation was 52.1 mL/min and 49.1 mL/min and the mean serum creatinine levels were 1.55 ± 0.37 and 1.66 ± 0.51 mg/dL in the ATG and basiliximab groups, respectively. A low incidence of tuberculosis and cytomegalovirus (CMV) was observed in the ATG group. There were no significant differences between the two groups, and both induction regimens assured a safe and effective treatment and were associated with similar excellent long-term patient and graft survival.