Five-year follow up of thymoglobulin versus ATGAM induction in adult renal transplantation.
BACKGROUND
One-year results of a randomized, double-blinded trial of Thymoglobulin versus Atgam for induction therapy in renal transplantation revealed that Thymoglobulin was associated with higher event-free survival (94% vs. 63%), less acute rejection (4% vs. 25%), and better graft survival. This article compares the safety and efficacy of Thymoglobulin versus Atgam induction through 5 years.


METHODS
Review and analysis of clinic records and electronic databases.


RESULTS
At 5 years, event-free survival (73% vs. 33%, P<0.001), graft survival (77% vs. 55%, P=0.047), and freedom from rejection (92% vs. 66%, P=0.007) were higher with Thymoglobulin versus Atgam. No additional cytomegalovirus (CMV) disease occurred after the first year with Thymoglobulin or Atgam (13% vs. 33%, P=0.056). There were two cases of posttransplant lymphoproliferative disorder (PTLD) with the Atgam arm and none with Thymoglobulin. Thymoglobulin was associated with profound lymphopenia at 2 years after transplantation.


CONCLUSIONS
Thymoglobulin was associated with higher event-free survival, graft survival, and freedom from rejection without increased PTLD or CMV disease at 5 years compared with Atgam. The prolonged and profound lymphopenia may contribute to the long-term results associated with Thymoglobulin.
Hardinger
Karen L
KL
Department of Pharmacy, Washington University School of Medicine, St. Louis, MO, USA.
Schnitzler
Mark A
MA
Miller
Brent
B
Lowell
Jeffrey A
JA
Shenoy
Surendra
S
Koch
Matthew J
MJ
Enkvetchakul
Decha
D
Ceriotti
Connie
C
Brennan
Daniel C
DC
D000328:Adult; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology* / Q000401:mortality / Q000517:prevention & control; D006085:Graft Survival / Q000276:immunology*; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000276:immunology; D013601:T-Lymphocytes / Q000276:immunology*; D019172:Transplantation Conditioning / Q000379:methods; D016896:Treatment Outcome
D000961:Antilymphocyte Serum