Two-day induction with thymoglobulin in kidney transplantation: risks and benefits.
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.
Uslu
A
A
SSK Izmir Teaching Hospìtal, Organ Transplantation and Research Center, Izmir, Turkey. yzboglu@ttnet.net.tr
Nart
A
A
Coker
I
I
Köse
S
S
Aykas
A
A
Kahya
M C
MC
Yüzbaşioğlu
M F
MF
Doğan
M
M
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
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; C488629:azathiopurine; D011239:Prednisolone; D015122:Mercaptopurine