Induction versus noninduction therapy in kidney transplantation: considering different PRA levels and different induction therapies

• Published in: Transplantation proceedings 2004-05, Vol.36 (4), p.874-876
• Main Authors: Castro, M.C.R, Araujo, L.M.P, Nahas, W.C, Arap, S, David-Neto, E, Ianhez, L.E
• Format: Article
• Language: English
• Subjects: Adult; Antilymphocyte Serum - therapeutic use; Biological and medical sciences; Drug Administration Schedule; Graft Rejection - classification; Graft Rejection - pathology; Humans; Immunosuppression - methods; Immunosuppressive Agents - therapeutic use; Isoantibodies - blood; Kidney Transplantation - immunology; Kidney Transplantation - pathology; Kidney Transplantation - physiology; Medical sciences; Postoperative Period; Renal Replacement Therapy - statistics & numerical data; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Transplantation Conditioning
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2004.03.084

To evaluate the rate of acute cellular rejection (ACR) and long-term results in different levels of anti-HLA sensitization, using noninduction or different induction therapies, 763 patients who underwent transplantation from January 1995 to December 2001 were evaluated: 213 patients received induction therapy, 71 received Thymoglobulin (Thymo), 66 Simulect, and 44 OKT3. Follow-up time was at least 1 year for all groups. The Simulect group included older recipients and the OKT3 group had more female patients. Simulect and OKT3 groups had more black patients; Thymo and OKT3 groups had more retransplantations. PRA was low in the noninduction group (mean, 7%) and about the same in the Simulect and Thymo groups (mean, 30%). OKT3 was the most sensitized group (mean = 59%). Dialysis during the first posttransplantation week was more frequent among the induction groups (43% vs 65%; P < .005). Fewer patients experienced rejection episodes in the Thymo group (20% vs 50%; P = .02). Patients were classified according to their level of sensitization, and the Thymo group showed the lower rejection rates in all levels (mean, 20%; P = .001). When analyzing PRA >50%, the Thymo group showed lower rejection rates (12% vs 50%; P = .02). At this level of sensitization, there was no significant difference on graft loss and death with a functioning graft. There was a trend to more cytomegalovirus (CMV) disease in the Thymo group (33% vs 23%; P = .08). Two PTLD were diagnosed, both in the noninduction group. Renal function was better in the Thymo group (1.3 mg/dL). In conclusion, Thymo showed lower ACR rates in all PRA groups. No significant differences in CMV infection, tumors, and patient survival were observed.