Thymoglobulin versus ATGAM induction therapy in pediatric kidney transplant recipients: a single-center report.
BACKGROUND
Induction immunosuppressive therapy with the anti-T-cell antibody Thymoglobulin decreases the incidence of acute rejection in adult kidney transplant (KTx) recipients, but limited data are available for pediatric KTx recipients.


METHODS
We conducted a historical cohort study to compare rates of survival, rejection, and infection in pediatric (age <19 years) KTx recipients who received induction therapy with polyclonal antibody, ATGAM (n=127) or Thymoglobulin (n=71), from December 1, 1992, to January 31, 2003. Maintenance immunosuppression included cyclosporine, azathioprine or mycophenolate mofetil, and prednisone. Mean follow-up was 90+/-25 months for ATGAM recipients and 32+/-15 months for Thymoglobulin recipients.


RESULTS
Overall, the incidence of acute rejection was lower in Thymoglobulin recipients versus ATGAM recipients (33% vs. 50%, P=0.02). Epstein-Barr virus (EBV) infection was higher in Thymoglobulin recipients versus ATGAM recipients (8% vs. 3%, P=0.002). But the two groups did not significantly differ in patient and graft survival rates, incidence of chronic rejection, EBV lymphoma, or other infection.


CONCLUSIONS
Thus, Thymoglobulin induction was associated with a decreased incidence of acute rejection and an increased incidence of EBV infection in pediatric KTx recipients. EBV monitoring should be performed in EBV-naive recipients receiving Thymoglobulin.
Khositseth
Sookkasem
S
Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota 55455, USA.
Matas
Arthur
A
Cook
Marie E
ME
Gillingham
Kristen J
KJ
Chavers
Blanche M
BM
D000293:Adolescent; D000961:Antilymphocyte Serum / Q000276:immunology / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival / Q000187:drug effects / Q000276:immunology; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D007223:Infant; D007239:Infections / Q000150:complications; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D015996:Survival Rate; D013601:T-Lymphocytes / Q000276:immunology*; D016896:Treatment Outcome
D000961:Antilymphocyte Serum