title: Induction antibody therapy in renal transplantation using early steroid withdrawal: long-term results comparing anti-IL2 receptor and anti-thymocyte globulin.
abstract: BACKGROUND
  The present study intends to investigate the effects of anti-IL2 receptors (anti-IL2R) vs. lymphocyte-depleting agents in the early steroid withdrawal (ESW) scheme.
  
  
  METHODS
  This is a retrospective cohort of 167 consecutive adult renal transplant recipients. Immunosuppression was based on tacrolimus and mycophenolate mofetil. Antibody induction therapy was carried out with lymphocyte-depleting agent (thymoglobulin) or anti-IL2R (Basiliximab or Daclizumab). ESW protocol was performed by administering intravenous methlyprednisolone as follows: 500 mg on day 0, 250 mg on day 1, 125 mg on day 2, 60 mg on day 3, and then stopped.
  
  
  RESULTS
  Among the 167 studied patients, 79 (47.3%) received anti-IL2R and 88 (52.7%) received thymoglobulin induction. Significantly fewer episodes of acute rejection were seen at one year in patients treated with thymoglobulin as compared to anti-IL2R (25.6% vs. 11.4%, p=0.01). At five years, a significant difference in graft survival was observed in anti-IL2R-treated patients compared with thymoglobulin (83.5% vs. 95.5%, p=0.01). Multivariate analysis disclosed that female sex, antibody induction therapy using thymoglobulin and a trough tacrolimus level higher than 10 were protective factors against acute rejection, while there was a trend to increased risk of acute rejection at first year post-transplantation in patients presenting delayed graft function (DGF). Antibody induction was independently associated with patient and graft survival at five years (OR 0.213, 95% CI 0.046-0.991, p=0.04).
  
  
  CONCLUSIONS
  ESW scheme seems to be safe and its use is beneficial since there are fewer adverse effects. Thymoglobulin induction therapy is associated with fewer rejection episodes. Induction therapy with thymoglobulin is associated with higher patient and allograft survival when comparing with anti-IL2R.
authors.affiliation: Division of Nephrology, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil. alexandreliborio@yahoo.com.br
authors.forename: Alexandre B
authors.initials: AB
authors.lastname: Libório
authors.forename: Talita R
authors.initials: TR
authors.lastname: Mendoza
authors.forename: Ronaldo M
authors.initials: RM
authors.lastname: Esmeraldo
authors.forename: Maria Luiza M B
authors.initials: ML
authors.lastname: Oliveira
authors.forename: Fernando J V Nogueira
authors.initials: FJ
authors.lastname: Paes
authors.forename: Geraldo B
authors.initials: GB
authors.lastname: Silva Junior
authors.forename: Elizabeth F
authors.initials: EF
authors.lastname: Daher
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use*; D000961:Antilymphocyte Serum / Q000008:administration & dosage / Q000627:therapeutic use*; D000077552:Basiliximab; D015331:Cohort Studies; D000077561:Daclizumab; D051799:Delayed Graft Function / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D060828:Induction Chemotherapy / Q000379:methods*; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000276:immunology; D008212:Lymphocyte Depletion / Q000379:methods; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000627:therapeutic use; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D015375:Receptors, Interleukin-2 / Q000037:antagonists & inhibitors*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000961:Antilymphocyte Serum; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D015375:Receptors, Interleukin-2; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab; D000077561:Daclizumab; C512542:thymoglobulin; D008775:Methylprednisolone