Efficacy and Safety of Thymoglobulin and Basiliximab in Kidney Transplant Patients at High Risk for Acute Rejection and Delayed Graft Function

Abstract

Objectives: To compare the efficacy and safety of thymoglobulin compared with basiliximab in patients who had kidney transplants and are at high risk for acute rejection and delayed graft function. Materials and Methods: A retrospective review of patients who had 1 or more risk factors for acute rejection and delayed graft function and who were given either thymoglobulin or basiliximab for induction therapy. Incidences of acute rejection, antibody-treated acute rejection, delayed graft function, chronic rejection, cancer, infection, leucopenia, and thrombocytopenia were compared between thymoglobulin and basiliximab groups. Serum creatinine levels within 1 year and long-term graft and patient survival also were compared. Results: A total of 327 patients were included. Incidences of acute rejection, antibody-treated acute rejection, delayed graft function, and chronic rejection were significantly lower in the thymoglobulin group than in the basiliximab group (P < .05). Serum creatinine levels were lower in the thymoglobulin group on postoperative days 7, 14, and 30 (P < .05). There were no statistically significant differences regarding long-term graft and patient survival, cancer, or total infection rate between the groups. Incidences of Cytomegalovirus infection, leucopenia, and thrombocytopenia were significantly higher in the thymoglobulin group (P < .05). Conclusions:Thymoglobulin may improve shortterm outcomes, compared with basiliximab, in patients who had kidney transplants and are at high risk for acute rejection and delayed graft function. However, long-term outcomes are similar with thymoglobulin and basiliximab.

New Factors Predicting Delayed Graft Function: a Multi-Center Cohort Study of Kidney Donation After Brain Death Followed by Circulatory Death

“…Chapal et al also found five explicative variables that contributed significantly to DGF prediction, and demonstrated that risk of DGF was reduced 1.73-fold in patients with ATG [6]. Other studies also demonstrated significantly lower rates of DGF in ATG-induced DCD recipients [24][25][26]. Our results demonstrated that ATG as induction therapy in DBCD donation could reduce the risk of DGF by more than half.…”

Predictors and One-year Outcomes of Patients with Delayed Graft Function after Deceased Donor Kidney Transplantation

“…While immunity induction is an important step before surgery to avoid acute rejection, the use of ATG induction remains controversial. ATG may be more likely to induce cytomegalovirus infections and hematological complications [19,20] . Popat et al [21] reported a lower DGF rate in the ATG-induced group among 45 patients in a single-center study.…”

Kidney transplant after hematopoietic cell transplant in pediatrics: Infectious and immunosuppressive considerations

“…In studies of KTx recipients at high‐risk for acute rejection (defined variably as those receiving a deceased donor kidney, high panel reactive antibody scores, or early/repeat allograft rejection history), use of T‐cell‐depleting ATG or alemtuzumab as opposed to T‐cell inhibitory anti‐IL2Rα antibodies such as basiliximab and daclizumab reduced acute rejection rates of high‐risk to those of standard risk patients . However, as anticipated, increased immunosuppression resulted in increased rates of infection . While it would be compelling to correlate duration of action of the induction immunosuppressant agent with timing of viral reactivation, this is not possible in our small cohort, nor was such a correlation found in a larger study of 106 pediatric KTx recipients (the Immune Development in Pediatric Transplantation [IMPACT] study).…”