Rabbit antithymocyte globulin is more beneficial in standard kidney than in extended donor recipients.
BACKGROUND
In a randomized, international study comparing rabbit antithymocyte globulin (TMG) and basiliximab (BAS) induction in renal transplant recipients at risk for delayed graft function or acute rejection (n=278), TMG was associated with less acute rejection at 1 year.


METHODS
This study analyzed outcomes stratified by standard criteria donor (SCD), extended criteria donor (ECD), and hypertensive donor. Data-capture limitations necessitated defining ECD as donor age more than 60 years or 50 to 60 years with hypertension and renal insufficiency.


RESULTS
Seventy-five recipients received ECD-kidneys (28.4% TMG vs. 25.6% BAS, P=NS) and 203 recipients received SCD-kidneys (72.6% TMG vs. 74.4% BAS, P=NS). Recipients of an ECD or hypertensive donor-kidney had similar outcomes between treatment groups. Recipients of an SCD-kidney treated with TMG had less rejection (odds ratio [OR] 0.48). Recipients of a normotensive donor-kidney treated with TMG had less rejection (OR 0.56). Recipients of a normotensive, SCD-kidney treated with TMG had less rejection (OR 0.47) and death (OR 0.17) than their counterparts treated with BAS.


CONCLUSIONS
Contrary to its perceived niche in recipients of ECD-kidneys, TMG was most beneficial in patients who received a normotensive, deceased SCD kidney.
Hardinger
Karen L
KL
Department of Pharmacy Practice, University of Missouri-Kansas City, Kansas City, MO, USA.
Brennan
Daniel C
DC
Schnitzler
Mark A
MA
D000368:Aged; D000818:Animals; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D001794:Blood Pressure; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality; D008875:Middle Aged; D018579:Patient Selection; D011817:Rabbits; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data*; D016896:Treatment Outcome
D000961:Antilymphocyte Serum