title: Comparison of two dosages of thymoglobulin used as a short-course for induction in kidney transplantation.
abstract: Thymoglobulin is used effectively as an induction agent in kidney transplantation, but the optimal dose is not well established. We evaluated the degree and durability of T-cell clearances with two different thymoglobulin regimens in adult kidney transplant recipients (KTR). Seven KTR received a 3-day thymoglobulin-based induction of 1.0 mg/kg/day while nine received 1.5 mg/kg/day, in addition to maintenance immunosuppression. Lymphocyte subsets were monitored for 6 months. Renal function, infections and malignancies were monitored for 24 months. T-cell subsets were significantly lower by day 30 with the thymoglobulin 1.5 mg/kg/day regimen when compared with the 1.0 mg/kg/day regimen; this trend was sustained at 6-month (CD3(+): 438 +/- 254 vs. 1001 +/- 532 cells/mm(3), P = 0.016). Renal function between the two groups was not significantly different at 6- and 24-months post-transplant. One case of BK Virus viremia in the 1.5 mg/kg/day thymoglobulin group was detected. No acute rejection episodes, cytomegalovirus infections, or malignancies were noted in either group. Thymoglobulin induction was efficacious in both groups, but with a significantly sustained T-cell clearance in the 1.5 mg/kg/day regimen. A more profound T-cell clearance within the first 6 months postinduction therapy may translate into a decreased risk of immunological injury and improved long-term outcome after kidney transplantation.
authors.affiliation: Renal and Transplantation Units, Massachusetts General Hospital and Harvard Medical School Boston, Boston, MA 02114, USA. wwong@partners.org
authors.forename: Waichi
authors.initials: W
authors.lastname: Wong
authors.forename: Neerja
authors.initials: N
authors.lastname: Agrawal
authors.forename: Manuel
authors.initials: M
authors.lastname: Pascual
authors.forename: David C
authors.initials: DC
authors.lastname: Anderson
authors.forename: Hans H
authors.initials: HH
authors.lastname: Hirsch
authors.forename: Kumiko
authors.initials: K
authors.lastname: Fujimoto
authors.forename: Francesca
authors.initials: F
authors.lastname: Cardarelli
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
authors.forename: A Benedict
authors.initials: AB
authors.lastname: Cosimi
authors.forename: Nina
authors.initials: N
authors.lastname: Tolkoff-Rubin
mesh_terms: D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects; D000961:Antilymphocyte Serum; D004306:Dose-Response Relationship, Immunologic; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods; D016030:Kidney Transplantation / Q000276:immunology; D018655:Lymphocyte Count; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D016176:T-Lymphocyte Subsets / Q000276:immunology; D013997:Time Factors
chemical_list: D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; C512542:thymoglobulin