Clinical Experience With Thymoglobulin and Antithymocyte Globulin-Fresenius as Induction Therapy in Renal Transplant Patients: A Retrospective Study

Abstract

Objectives: We describe our experiences with, and compare the outcomes of, 2 groups of renal transplant patients treated with thymoglobulin or antithymocyte globulin-Fresenius as induction therapy at transplant to reduce the incidence of acute rejection and prevent delayed allograft function. Materials and Methods: Twenty-four recipients of deceased-donor or living-donor kidney transplants received thymoglobulin, and 23 patients received antithymocyte globulin-Fresenius. Patient and graft survival and efficacy and safety were assessed at 3 months. Results: The demographic characteristics of both groups were comparable, but the predominant donor type was significantly different. Incidence of complications, delayed graft function, and creatinine concentrations were comparable in both groups. At 3 months after the transplant, patient survival rate was 92% in the thymoglobulin group and 96% in the antithymocyte globulinFresenius group (P > .05), and death-censored graft survival rate for both groups was not significantly different. Average hematocrit and lymphocyte, neutrophil, and platelet counts were comparable in both groups at 3 months' follow-up. Average white blood count at 1 month was significantly different between the groups: at 5.62 ± 2.45 × 10 3 cells/mm 3 in the thymoglobulin group and 7.85 ± 4.10 × 10 3 cells/mm 3 in the ATG-F group (P < .05). Conclusions: Considering the study design limitations, we observed that our group of treated patients, safety, and efficacy of thymoglobulin and antithymocyte globulin-Fresenius were generally comparable.

Comparison of efficacy and safety between rabbit anti‐thymocyte globulin and anti‐T lymphocyte globulin in kidney transplantation from donation after cardiac death: A retrospective cohort study

“…Thymoglobulin and ATG‐F are polyclonal antibodies used in induction therapy for deceased kidney transplantation. These antibodies have been shown in prior studies to reduce DGF or acute rejection after kidney transplantation . However, their efficacy and safety have not been compared directly to each other.…”

“…Induction therapy can reduce the DGF and acute rejection rate after kidney transplantation, thus it is widely used in DCD kidney transplantation. Thymoglobulin and ATG‐Fresenius (ATG‐F) are the two most common antibodies used in induction therapy, and several studies have shown that both drugs can effectively reduce acute rejection rate and improve graft survival after deceased kidney transplantation . However, no study thus far has directly compared these two drugs in DCD kidney transplantation.…”

Effectiveness and safety of two different antithymocyte globulins used in induction therapy in kidney transplant recipients: A single‐center experience

“…There was also no significant difference in the frequency of nonfatal infectious complications, including CMV infection, between the two ATG formulations, which is consistent with previous observations. 14,15 In contrast, Ducloux et al reported a higher incidence of CMV infections and deaths in the Thymoglobulin group; however, the study used much higher cumulative doses of both agents. 16 Indeed, the benefits of induction therapy with ATGs must be weighed against post-transplant complications, including life-threatening infections.…”

“…Early reports [11][12][13] yielded conflicting results on the frequency of acute rejection episodes and treatment safety issues. The literature after 2000 includes only two small studies (a retrospective analysis with a follow-up period of 3 months 14 and a prospective randomized control study with DSA-positive recipients only 15 ), one retrospective study in 255 kidney transplants from donation after cardiac death, with a short ATG low-dose induction protocol 1 ; and the study by Ducloux et al 16 , which reported a greater incidence of CMV disease, malignancy, and death among patients treated with Thymoglobulin induction. Importantly, this large cohort was treated predominantly with cyclosporine A and azathioprine, and the ATGfixed cumulative doses were relatively high, that is, 21 mg/kg in the ATG-Fresenius and 13 mg/kg in the Thymoglobulin group.…”

Induction of suppressive allogeneic regulatory T cells via rabbit antithymocyte polyclonal globulin during homeostatic proliferation in rat kidney transplantation

“…Using retroviral expression cloning, they identified differences in the antibodies directed to target antigens, which could possibly generate clinical variation . Some authors have evaluated possible differences between the two pharmacological presentations but not yet conclusive . Taking into account this data, the potential distinct immunosuppressive and immunomodulatory effects between the different ATG preparations in organ transplantation should be further analysed in controlled clinical trials.…”