20-year follow-up results of a randomized controlled trial comparing antilymphocyte globulin induction to no induction in renal transplant patients.
BACKGROUND
The purpose of this study was to determine the impact of antilymphocyte globulin (ALG)-induction on long-term outcomes of postrenal transplantation.


METHODS
Between January 1985 and January 1986, 123 consecutive renal transplants from deceased donors were performed at a single institution. Patients were randomized into two groups: group 1 (n=63, 40+/-10 year) received cyclosporine (CsA), prednisone, and azathioprine; and group 2 (n=60, 36+/-9 year) received ALG-induction, CsA, and prednisone and delayed initiation (45-90 days posttransplantation) of azathioprine if the CsA dose was less than 4 mg/kg per day. Target CsA trough levels were 150 to 250 ng/mL. Cytomegalovirus prophylaxis was not used. Human leukocyte antigen matching (2.4+/-1.1 vs. 2.6+/-1.2) and cold ischemia time (38+/-8 hr vs. 39+/-9 hr) did not differ.


RESULTS
The incidence of acute rejection was lower in group 2 (28% vs. 75%, P<0.0001). The incidence of cytomegalovirus infection was 10% in group 1 and 18% in group 2 (P=0.41). The incidence of cancer was 22.2% in group 1 and 11.7% in group 2 (P=0.53) and the incidence of lymphoma did not differ (3% vs. 5%, P=0.77). Patient and graft survival in groups 1 and 2 at 1, 10, and 20 years were 100%/79% vs. 100%/93%, 83%/56% vs. 88%/51%, and 64%/43% vs. 54%/47%, respectively (log-rank test, P=0.18 and P=0.078).


CONCLUSIONS
The use of ALG-induction resulted in a lower incidence of acute rejection and improved graft survival during the first year postrenal transplantation. Patient and graft survival at 20-year follow-up was not affected by ALG-induction.
Cantarovich
Marcelo
M
Multi-Organ Transplant Programme, McGill University Health Center, Montréal, Québec, Canada. marcelo.cantarovich@muhc.mcgill.ca
Durrbach
Antoine
A
Hiesse
Christian
C
Ladouceur
Martin
M
Benoit
Gerard
G
Charpentier
Bernard
B
D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D001379:Azathioprine / Q000627:therapeutic use; D003131:Combined Modality Therapy; D016572:Cyclosporine / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology*; D009369:Neoplasms / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000276:immunology* / Q000821:virology; D011241:Prednisone / Q000627:therapeutic use; D016019:Survival Analysis; D013997:Time Factors
D000961:Antilymphocyte Serum; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D001379:Azathioprine; D011241:Prednisone