title: Rabbit antithymocyte induction and dosing in deceased donor renal transplant recipients over 60 yr of age.
abstract: BACKGROUND
  Antithymocyte globulin (rATG) is a commonly used induction agent in renal transplantation; however, data in older kidney recipients are limited.
  
  
  METHODS
  We reviewed charts of 301 deceased donor renal transplants who received a protocol consisting of 3-7 doses of rATG and triple maintenance therapy. Outcomes of patients >60 yr of age (n = 45) were compared to those aged 18-59 yr (n = 256).
  
  
  RESULTS
  Older recipients had more diabetics, were more likely to receive expanded criteria donor kidneys (p < 0.01), and over 30% were sensitized. Recipients >60 received less cumulative rATG (4.6 vs. 5.1 mg/kg; p < 0.01). Three-yr acute rejection was lower in the >60 group (2% vs. 16%, p < 0.01) although glomerular filtration rates were similar between groups. Actuarial graft survival was similar; however, patient survival in the >60 group at three yr was lower (80% vs. 95%; p = 0.02). Specifically, patients >60 with delayed graft function and rATG cumulative dosing >6 mg/kg had a survival of <50% by two yr.
  
  
  CONCLUSIONS
  Recipients over 60 yr receiving rATG induction have acceptable renal function and a low risk of rejection; however, reduced survival was noted among those receiving >6 mg/kg. These data suggest that when used, lower cumulative dosages of rATG are preferable in the older recipient.
authors.affiliation: Department of Pharmacy Department of Surgery, The Methodist Hospital, Houston, TX, USA. sjpatel@tmhs.org
authors.forename: Samir J
authors.initials: SJ
authors.lastname: Patel
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Knight
authors.forename: Wadi N
authors.initials: WN
authors.lastname: Suki
authors.forename: Abdul
authors.initials: A
authors.lastname: Abdellatif
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Duhart
authors.forename: Amy G
authors.initials: AG
authors.lastname: Krauss
authors.forename: Saurabh
authors.initials: S
authors.lastname: Mannan
authors.forename: Nosratollah
authors.initials: N
authors.lastname: Nezakatgoo
authors.forename: A
authors.initials: A
authors.lastname: Osama Gaber
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D002102:Cadaver; D003404:Creatinine / Q000097:blood; D051799:Delayed Graft Function; D004305:Dose-Response Relationship, Drug; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000276:immunology*; D006085:Graft Survival / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007167:Immunotherapy; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011817:Rabbits; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D003404:Creatinine