Effects of intraoperative versus postoperative administration of rabbit antithymocyte antibodies on 1-year renal function in renal transplant patients.
OBJECTIVE
The aim of our study was to prospectively assess 1-year allograft outcomes and the evolution of lymphocyte subsets in a group of renal transplant patients who had received intraoperative rabbit antithymocyte antibodies (RATG).


METHODS
We compared 1-year allograft transplant outcomes in renal transplant recipients who had received intraoperative RATG (group 1, n=53) with the outcomes observed in patients in a historical control group who had received postoperative RATG (group 2, n=49). RATG were given at the same dosage (1 mg/kg) during the first 3 days, and then the dosage was adapted according to CD2 count, until calcineurin inhibitors were started.


RESULTS
The overall dosage of RATG administered was significantly lower in group 1. At day 4, CD2, CD3, and CD19 T-cell subset counts were significantly higher in patients in group 1. From 3 months after transplantation, CD4/CD8 ratios were significantly lower in patients in group 1 because of a rapid regeneration of CD8 T cells. One-year total lymphocyte counts were significantly higher in patients in group 1. There were fewer severe infectious complications in patients in group 1. One-year renal function was better in patients in group 2. Donor age was the only independent factor associated with renal function at both 1 month and 1 year after transplantation.


CONCLUSIONS
When RATG are infused intraoperatively, a lower total amount of RATG is required to prevent acute rejection as compared with postoperative RATG infusion. Consequently, fewer serious lymphopenia-associated complications are observed during the first year after transplantation.
Kamar
Nassim
N
Department of Nephrology, Dialysis and Multiorgan Transplantation, CHU Rangueil, Toulouse, France. kamar.n@chu-toulouse.fr
Esposito
Laure
L
Ribes
David
D
Tkaczuk
Jean
J
Cointault
Olivier
O
Lavayssiere
Laurence
L
Abbal
Michel
M
Durand
Dominique
D
Rostaing
Lionel
L
D000328:Adult; D000818:Animals; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D003404:Creatinine / Q000097:blood / Q000652:urine; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007668:Kidney / Q000502:physiology; D016030:Kidney Transplantation / Q000276:immunology / Q000379:methods*; D016131:Lymphocyte Subsets / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011446:Prospective Studies; D011817:Rabbits; D016896:Treatment Outcome
D000961:Antilymphocyte Serum; D003404:Creatinine