Clinical and Economic Outcomes of Rabbit Antithymocyte Globulin Induction in Adults Who Received Kidney Transplants from Living Unrelated Donors and Received Cyclosporine-Based Immunosuppression

• Published in: Pharmacotherapy 2009-10, Vol.29 (10), p.1166-1174
• Main Authors: Miller, James T., Collins, Curtis D., Stuckey, Linda J., Luan, Fu L., Englesbe, Michael J., Magee, John C., Park, Jeong M.
• Format: Article
• Language: English
• Subjects: Adult; Animals; Antilymphocyte Serum - adverse effects; Antilymphocyte Serum - economics; Antilymphocyte Serum - therapeutic use; Biological and medical sciences; Cohort Studies; cost; Cyclosporine - therapeutic use; Female; Follow-Up Studies; Graft Rejection - economics; Graft Rejection - prevention & control; Humans; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - economics; Immunosuppressive Agents - therapeutic use; Kidney Transplantation - adverse effects; Kidney Transplantation - economics; Kidney Transplantation - methods; Living Donors; living unrelated donor kidney transplantation; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Postoperative Complications; rabbit antithymocyte globulin; Rabbits; rejection; Retrospective Studies; Thymoglobulin; Treatment Outcome
• ISSN: 0277-0008; 1875-9114
• DOI: 10.1592/phco.29.10.1166

Study Objective. To evaluate the efficacy, safety, and costs of rabbit antithymocyte globulin (TMG) induction in patients who received kidney transplants from living unrelated donors. Design. Retrospective cohort study. Setting. Large academic medical center. Patients. Eighty‐seven patients who received kidney transplants from living unrelated donors: 40 of the recipients underwent transplantation between January 1, 2003, and December 31, 2004, and did not receive TMG induction (no induction group); 47 underwent transplantation between January 1, 2005, and June 30, 2006, and received TMG induction (induction group). All patients received cyclosporine‐based immunosuppression. Measurements and Main Results. Biopsy‐proven acute rejection, posttransplantation complications, and inpatient hospital costs for the first 12 months after transplantation were compared between groups using standard univariate statistical analyses. Induction significantly decreased the occurrence of biopsy‐proven acute rejection versus no induction (2% vs 48%, p0.05). For the no induction versus induction groups, no significant differences in cytomegalovirus disease (5% vs 6%), malignancy (3% vs 2%), graft failures (5% vs 6%), mortality (5% vs 4%), and serum creatinine concentrations (mean ± SD 1.4 ± 0.3 vs 1.5 ± 0.3 mg/dl) were observed at 12 months (p>0.05 for all comparisons) Conclusion. Five‐day TMG induction effectively reduced the 1‐year acute rejection rate without significantly increasing total inpatient costs or posttransplantation complications among recipients of kidney transplants from living unrelated donors