title: Induction treatment with rabbit antithymocyte globulin versus basiliximab in renal transplant recipients with planned early steroid withdrawal.
abstract: OBJECTIVE
  To compare the safety and efficacy of rabbit antithymocyte globulin (r-ATG) with basiliximab in renal transplant recipients for whom an early steroid withdrawal (ESW) regimen was planned.
  
  
  METHODS
  Single-center, retrospective, cohort study.
  
  
  METHODS
  Tertiary care medical center, including inpatient hospital stays and outpatient nephrology clinics.
  
  
  METHODS
  Ninety-nine consecutive adult recipients of living- or deceased-donor renal transplants between January 1, 2004, and December 31, 2007, in whom ESW was planned and who received either r-ATG or basiliximab; patients receiving an extended-criteria kidney donation or a donation after cardiac death were excluded.
  
  
  RESULTS
  All patients received mycophenolate mofetil and tacrolimus as maintenance therapy with planned ESW. Induction therapy was either r-ATG 1.5 mg/kg/day for 4 days (68 patients) or basiliximab 20 mg on postoperative days 0 and 4 (31 patients). The primary composite end point of biopsy-proven acute rejection (BPAR), graft loss, and death occurred in 6 patients (9%) and 9 patients (29%) in the r-ATG and basiliximab groups at 1 year after transplantation, respectively (p=0.01), with rates of 7% (5/68 patients) and 26% (8/31 patients) for BPAR (p=0.02), 0% and 3% (1/31 patients) for graft loss (p=0.31), and 2% (1/68 patients) and 0% for patient death (p>0.99). Average time to first BPAR was significantly longer in the r-ATG group (mean ± SD 151.4 ± 82.9 vs 53.6 ± 68.4 days, p<0.01). Kidney function at 12 months was similar between the two groups.
  
  
  CONCLUSIONS
  Rabbit-ATG was associated with a lower frequency and delayed onset of BPAR compared with basiliximab in renal transplant recipients who received an ESW regimen.
authors.affiliation: Department of Pharmacy Services, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA. spm9005@nyp.org
authors.forename: Spencer T
authors.initials: ST
authors.lastname: Martin
authors.forename: Keri L
authors.initials: KL
authors.lastname: Roberts
authors.forename: Sayeed K
authors.initials: SK
authors.lastname: Malek
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Tullius
authors.forename: Nidyanandh
authors.initials: N
authors.lastname: Vadivel
authors.forename: Sacha
authors.initials: S
authors.lastname: De Serres
authors.forename: Monica
authors.initials: M
authors.lastname: Grafals
authors.forename: Abdelaziz
authors.initials: A
authors.lastname: Elsanjak
authors.forename: Beth Anne
authors.initials: BA
authors.lastname: Filkins
authors.forename: Anil
authors.initials: A
authors.lastname: Chandraker
authors.forename: Steven
authors.initials: S
authors.lastname: Gabardi
mesh_terms: D000328:Adult; D000818:Animals; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D000961:Antilymphocyte Serum / Q000009:adverse effects / Q000627:therapeutic use*; D000077552:Basiliximab; D001706:Biopsy; D015331:Cohort Studies; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011817:Rabbits; D011993:Recombinant Fusion Proteins / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab; D009173:Mycophenolic Acid; D016559:Tacrolimus