Long-term evaluation of single bolus high dose ATG induction therapy for prophylaxis of rejection in live donor kidney transplantation.
OBJECTIVE
The long-term evaluation of single bolus high dose antithymocyte globulin (ATG) induction therapy has not been adequately studied. We aimed to evaluate its long-term effects in the living related donor kidney transplantation.


METHODS
Eighty adult recipients with their first kidney allograft were randomized into two equal treatment groups, one group received intraoperative single bolus rabbit ATG in a dose of 9 mg/kg and the second group served as a control. All patients were maintained on triple immunosuppressive therapy (steroids, calcineurin inhibitor and antiproliferative agent). We followed them thoroughly for minimum of 5 years.


RESULTS
ATG significantly reduced the proportion of patients who experienced acute rejection episodes in the first year (9/40) when compared to the control group (26/40) and in 5 years (11/40) when compared to (30/40) in controls. The cumulative steroid dose used throughout the study was significantly lower in the ATG group. The overall incidence of posttransplant complications was comparable among the two treatment groups. There was no significant difference in patient and graft survival: 5 year survival was 100% and 85% for the ATG group, and 95% and 92.5% in the control group, respectively.


CONCLUSIONS
Although routine single bolus ATG induction significantly reduces the incidence of acute rejection, its long-term beneficial effects on graft function and patient and graft survival are not evident.
Sheashaa
Hussein A
HA
Urology & Nephrology Center, Mansoura University, Mansoura, Egypt. drhattia@yahoo.com
Hamdy
Ahmed F
AF
Bakr
Mohamed A
MA
Abdelbaset
Sherif F
SF
Ghoneim
Mohamed A
MA
D000328:Adult; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007262:Infusions, Intravenous; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D010951:Plasma Exchange; D011446:Prospective Studies
D000961:Antilymphocyte Serum; D005938:Glucocorticoids; D008775:Methylprednisolone