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

Abstract

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.

Induction Therapy in Renal Transplantation With Antithymocyte Globulin and Basiliximab- A Single Centre Retrospective Study

“…This includes the effects of CMV infection and Valganciclovir used for prophylaxis. This is more than previously done retrospective study in India by Kesiraju et al 4 The rate of bacterial, fungal and viral infections was comparable in both the groups. Similar to Liborio et al 11 The rate of Lower respiratory tract infection was higher in ATG group 15.2% vs. 10.5% in basiliximab group similar to Wang et al 13 The incidence of UTI was similar between the two groups (13.3% vs. 12.5%) in contrast to Huang et al 20 where there was higher incidence of UTI in ATG group.…”

“…In contrast to these studies Brennan et al 7 found higher incidence in basiliximab group. The incidence of CMV infection is more in both groups when compared to previous studies Kesiraju et al 4 who used lesser doses of ATG and used CMV prophylaxis in both groups but less than the incidence in Ulrich et al and Kim et al 12,14 There were two previous studies from India Kesiraju et al 4 and Patel et al The death censored graft loss was 3.8% in ATG group and 4.1% in the basiliximab group. Total graft loss was 8.9% in the ATG group and 7.58% in the basiliximab group less than previous studies done in India.…”

“…There was one previous retrospective study in India comparing induction strategies with ATG and basiliximab. 4 Many randomised controlled trials 3,5,6,7,8 and retrospective trials 4,9-17 were done to compare the induction agents.…”

Incidence Rate and Predictors of Delayed Graft Function Among Adult Kidney Transplant Recipients at a Tertiary Care Hospital in Riyadh, Saudi Arabia

“…Anti-thymocyte globulin (ATG) induction before transplantation, followed by a triple immunosuppressive regimen (MMF, prednisone, and tacrolimus) post-transplantation is common practice at KAMC. Studies have shown the effectiveness of immunosuppressive therapy, encompassing triple therapy and IL-2 receptor antibody basiliximab in reducing the rates of DGF among kidney recipients, and though the induction used differs from that of KAMC, both ATG and basiliximab are safe and effective options [28]. Triple immunosuppressive therapy and ATG induction were given to all patients in the present study.…”

Drug-Induced Hematological Cytopenia in Kidney Transplantation and the Challenges It Poses for Kidney Transplant Physicians

“…Incidence of leucopenia and thrombocytopenia in basiliximab-treated renal transplant patients are approximately 10%–15% and 5%, respectively [ 76 ]. Many comparative studies have demonstrated that leucopenia and thrombocytopenia occurred less in basiliximab [ 64 , 76 , 141 , 147 , 148 ] when compared to other agents used in induction. In the 3 C trial, leucopenia was 3.6 times higher in KTR receiving alemtuzumab as compared to basiliximab [ 147 ].…”