title: Two-day induction with thymoglobulin in kidney transplantation: risks and benefits.
abstract: BACKGROUND
  The aim of this study was to develop an induction protocol to reduce allograft rejection with fewer posttransplant infections and malignancies.
  
  
  METHODS
  In this prospective randomized study, a T- and B-cell depletion protocol, consisting of IV thymoglobulin (ATG 5 mg/kg/d) plus methylprednisolone (500 mg/d) plus azathiopurine (2 mg/kg/d), was on days 0 and 1 after renal transplantation. CyA was introduced at day 3.39 among patients undergoing either primary living related (n = 16) or cadaveric (n = 23) transplants excluding recipients of full-HLA-matched sibling, or five- and six-HLA-matched cadaveric donor kidneys. The adequacy of immunosuppression was evaluated by flow cytometric analysis for total, CD3+ (T-cell), and CD19+ (B-cell) lymphocytes.
  
  
  RESULTS
  The acute rejection rate was 6% and 37/39 patients are alive with functioning grafts at an average follow-up of 14.5 months. The overall patient and graft survival rate was 95%. Their mean creatinine value was 1.27 mg/dL. Six patients (16%) required hospitalization due to serious infections. The two deaths were attributed to septicemia and brain abcess caused by unusual agents, namely, Rhodococcus equi and Sporobolomyces. One patient presented with a cutaneous Kaposi sarcoma in the 11th month posttransplant.
  
  
  CONCLUSIONS
  A Two-day induction protocol with thymoglobulin yields acceptable acute rejection rates among renal transplants. However, caution is necessary for adverse events, particularly atypical bacterial and fungal infections.
authors.affiliation: SSK Izmir Teaching Hospìtal, Organ Transplantation and Research Center, Izmir, Turkey. yzboglu@ttnet.net.tr
authors.forename: A
authors.initials: A
authors.lastname: Uslu
authors.forename: A
authors.initials: A
authors.lastname: Nart
authors.forename: I
authors.initials: I
authors.lastname: Coker
authors.forename: S
authors.initials: S
authors.lastname: Köse
authors.forename: A
authors.initials: A
authors.lastname: Aykas
authors.forename: M C
authors.initials: MC
authors.lastname: Kahya
authors.forename: M F
authors.initials: MF
authors.lastname: Yüzbaşioğlu
authors.forename: M
authors.initials: M
authors.lastname: Doğan
mesh_terms: D000293:Adolescent; D000328:Adult; D000961:Antilymphocyte Serum / Q000009:adverse effects / Q000627:therapeutic use*; D001402:B-Lymphocytes / Q000276:immunology; D004359:Drug Therapy, Combination; D006085:Graft Survival / Q000187:drug effects / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality; D008212:Lymphocyte Depletion; D015122:Mercaptopurine / Q000031:analogs & derivatives / Q000627:therapeutic use; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D018570:Risk Assessment; D016019:Survival Analysis; D013601:T-Lymphocytes / Q000276:immunology
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; C488629:azathiopurine; D011239:Prednisolone; D015122:Mercaptopurine