title: The impact of thymoglobulin on renal function and calcineurin inhibitor initiation in recipients of orthotopic liver transplant: a retrospective analysis of 298 consecutive patients.
abstract: BACKGROUND
  Renal dysfunction remains the Achilles' heel of calcineurin inhibitor (CI)use. The purpose of this study was to assess our institutional, renal-sparing strategy using thymoglobulin (TMG) in recipients of orthotopic liver transplants.
  
  
  METHODS
  We performed a retrospective analysis of data from 298 adult recipients who were transplanted between 1991 and 2002. The patients were divided into two groups: those induced with TMG (group 1) and those that were not treated with this agent (group 2). A subgroup analysis was performed of patients with baseline serum creatinine values above 1.5 mg/dL (group 1A received TMG; group 2A did not). All patients received tacrolimus or cyclosporine (CyA) maintenance immunosuppression.
  
  
  RESULTS
  Indications and demographics were similar between the two groups. Although there was no difference in patient and graft survivals, there was a statistically significant benefit in the rejection-free graft survival at 1 year for group 1 (51% vs 39%; P =.02). Furthermore, serum creatinine at 6 months was lower for group 1, despite a similar baseline creatinine. Subgroup analysis for patients with baseline abnormal serum creatinines showed that group 1A displayed an improved rejection-free graft survival at 1 month but not at 1 year.
  
  
  CONCLUSIONS
  Thymoglobulin induction therapy may allow a delay in the initiation of CI therapy without compromising patient and graft survival, while preventing early rejection, even among patients with baseline renal dysfunction.
authors.affiliation: Department of Surgery, Section of Transplantation, Royal Victoria Hospital, McGill University Health Center, Montreal, Quebec, Canada. jean.tchervenkov@much.mcgill.ca
authors.forename: J I
authors.initials: JI
authors.lastname: Tchervenkov
authors.forename: G N
authors.initials: GN
authors.lastname: Tzimas
authors.forename: M
authors.initials: M
authors.lastname: Cantarovich
authors.forename: J S
authors.initials: JS
authors.lastname: Barkun
authors.forename: P
authors.initials: P
authors.lastname: Metrakos
mesh_terms: D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D065095:Calcineurin Inhibitors; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007677:Kidney Function Tests; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D000961:Antilymphocyte Serum; D065095:Calcineurin Inhibitors; D003404:Creatinine