Intraoperative anti-thymocyte globulin-Fresenius (ATG-F) administration as induction immunosuppressive therapy in kidney transplantation.
We reviewed 43 adult kidney transplant patients (32 males and 11 females, 14-68 years of age) performed at our center between July 1999 and February 2002. Donors (39 males and 4 females) comprised two cadaverics, five living-related and 36 living-unrelated; age 18-44 years. Indications for kidney transplantation (KT) were: chronic glomerulonephritis (8), re-transplantation (4) and chronic pyelonephritis (3); kidney disease was unknown in 15 cases. ATG-F was given as a single intra-operative bolus induction therapy in 26 patients; extended ATG-F dose was given in 17 patients because of a high sensitization status, slow graft function (SGF) or development of calcineurin inhibitors toxicity. ATG-F was stopped in seven out of 17 patients because of thrombocytopenia or severe anemia. ATG-F-related fever occurred in six patients. Acute rejection (AR) occurred in eight patients (18%) 5-11 days post-KT. ATG-F was given in three steroid-resistant AR. Infection occurred in 19 patients (44%) for a total of 32 infectious episodes comprising 24 bacterial infections (nine urinary, seven catheter-related and three respiratory), six viral infections (five CMV and one herpes) and two fungal infections (one pulmonary aspergillosis and one catheter-related candidiasis). The hospital stay was 8-75 days for a median of 13 days. The mean serum creatinine upon discharge, at 1 and 6 months after KT were: 2.04+/-0.37, 1.43+/-0.16 and 1.29+/-0.08, respectively. One patient lost his graft on day 9 because of graft microthrombi related to Factor V-Leiden mutation. The 6 months actuarial patient and graft survival were 100 and 97.6%, respectively. ATG-F as a bolus therapy is an effective and safe induction treatment in KT.
Abou-Jaoude
Maroun M
MM
St-George Hospital, Beirut, Lebanon.
Almawi
Wassim Y
WY
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000209:etiology; D000961:Antilymphocyte Serum / Q000008:administration & dosage* / Q000009:adverse effects; D001424:Bacterial Infections / Q000209:etiology; D003404:Creatinine / Q000097:blood; D005260:Female; D005334:Fever / Q000209:etiology; D006084:Graft Rejection / Q000188:drug therapy / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D007432:Intraoperative Period; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D012449:Safety; D013601:T-Lymphocytes / Q000276:immunology*; D013921:Thrombocytopenia / Q000209:etiology; D014777:Virus Diseases / Q000209:etiology
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D003404:Creatinine