Short Course Induction Immunosuppression With Thymoglobulin for Renal Transplant Recipients1

Abstract

Three-day induction with thymoglobulin is as effective and safe as seven days, decreases initial hospitalization and causes more sustained lymphocyte depletion.

Basiliximab Combined with Low-Dose Rabbit Anti-Human Thymocyte Globulin

“…These findings suggest that at lower-than-standard doses, RATG induction does not result in excess immunosuppression, even in combination with anti-IL-2R mAb. Our study was not powered to assess whether the low-dose regimen also could avoid the excess long-term risk for opportunistic infections, lymphoproliferative disorders, or malignancies associated with standard thymoglobulin-based induction regimens (41)(42)(43). On the basis of previous findings, however, patients who were exposed to less RATG were at lower risk (20).…”

Immunological induction with thymoglobulin: reduction in the number of doses in renal transplant from deceased donor

“…Nevertheless, even with the increase in CIT and the DGF rate, no increase in the incidence of AR or any impact on the renal graft function was observed in up to one year follow-up, suggesting that, even without reducing the risk of DGF, the use of thymoglobulin may be associated with protection from the late effects of IRI on the renal graft (20) . Although many clinical trials demonstrated that immunological induction with thymoglobulin is safe and effective (12)(13)(14)(15)(16) , the best regimen with regard to number of doses, frequency and accumulated antibody dose has not been established yet. A great part of the experience with the use of antibodies in kidney transplantation was acquired by its use for the treatment of AR, which, in some protocols, reached a total of 14 doses.…”

“…A great part of the experience with the use of antibodies in kidney transplantation was acquired by its use for the treatment of AR, which, in some protocols, reached a total of 14 doses. Ever since, several studies compared a number of induction protocols, in order to define how many doses or how many days of treatment would be necessary to establish a safety profile for the use of thymoglobulin for immunological induction (13,14) . In this study, in Group 1, a protocol extrapolating from the one indicated for the treatment of AR was used, allowing the use of up to 14 doses, provided the patients remained in DGF.…”

“…Later on, some published clinical trials comparing thymoglobulin induction protocols confirmed that the use of five to seven doses was safe and effective. Recently, new published data have indicated that an accumulated thymoglobulin dose between 4.0 e 7.0 mg/kg warranted excellent results, regardless of the frequency of antibody administration (12)(13)(14)(15)(16) . In the last period analyzed, defined as Group 3, four doses were used, amounting to an accumulated dose of 4.5 mg/kg.…”

“…Historically, different protocols with intravenous doses varying from 7 to 14 days have been described (12) . Recently, a study comparing a short, three-day treatment with thymoglobulin with a historical control that used a greater number of doses demonstrated that the short treatment was as effective and safe as the longer one, besides reducing the post-transplantation hospital stay (13) . The current protocols focus mainly on an accumulated dose, using varying frequencies and administration times, and there is even a protocol with a single 5.0 mg/kg dose, shown to be able to produce an intense and lasting lymphopenia and to be as effective as all the others (14) .…”