Comparison of two dosages of thymoglobulin used as a short-course for induction in kidney transplantation.
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.
Wong
Waichi
W
Renal and Transplantation Units, Massachusetts General Hospital and Harvard Medical School Boston, Boston, MA 02114, USA. wwong@partners.org
Agrawal
Neerja
N
Pascual
Manuel
M
Anderson
David C
DC
Hirsch
Hans H
HH
Fujimoto
Kumiko
K
Cardarelli
Francesca
F
Winkelmayer
Wolfgang C
WC
Cosimi
A Benedict
AB
Tolkoff-Rubin
Nina
N
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
D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; C512542:thymoglobulin