title: Comparison of long-term effect of thymoglobulin treatment in patients with a high risk of delayed graft function.
abstract: BACKGROUND
  T-lymphocyte depletion is a strategy to reverse the impact of ischemia-reperfusion injury (IRI) in progression to chronic allograft dysfunction, especially among patients at high risk for delayed graft function (DGF).
  
  
  METHODS
  The present work assessed the effect of thymoglobulin among a population with a high incidence of DGF. We analyzed 209 transplanted patients: 97 in the thymoglobulin and 112 in the control group.
  
  
  RESULTS
  The main complication was DGF (59.3%), with a similar incidence in both groups (63.9% vs. 55.3%; P = .36). Acute rejection episodes (ARE) were decreased with thymoglobulin (8.2% vs. 28.5%; P < .001), but cytomegalovirus viremia was 3.4-fold more frequent (58.3% vs. 17.1%; P < .001). One-year graft function was significantly better in the thymoglobulin group (59.2 ± 17.2 vs. 51.8 ± 15.3 mL/min; P = .004), even when censored by ARE (59.7 ± 17.5 vs. 53.3 ± 14.4; P = .023). The same difference was observed at the 2-year follow-up (P = .024), even when censored for ARE (P = .045). A multivariate analysis showed thymoglobulin to be a factor strongly associated with protection of graft function (P = .039).
  
  
  CONCLUSIONS
  Despite not reducing the incidence of DGF, thymoglobulin induction significantly reduced the incidence of ARE and showed a long-term profile of protection of renal graft function, independent of the reduction in ARE.
authors.affiliation: Universidade Federal de São Paulo, Division of Nephrology, Sao Paulo, Brazil.
authors.forename: L R
authors.initials: LR
authors.lastname: Requião-Moura
authors.forename: E
authors.initials: E
authors.lastname: Ferraz
authors.forename: A C C
authors.initials: AC
authors.lastname: Matos
authors.forename: E J
authors.initials: EJ
authors.lastname: Tonato
authors.forename: K S
authors.initials: KS
authors.lastname: Ozaki
authors.forename: M S
authors.initials: MS
authors.lastname: Durão
authors.forename: N O S
authors.initials: NO
authors.lastname: Câmara
authors.forename: A
authors.initials: A
authors.lastname: Pacheco-Silva
mesh_terms: D000328:Adult; D000961:Antilymphocyte Serum / Q000008:administration & dosage* / Q000009:adverse effects; D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D050377:Cold Ischemia / Q000009:adverse effects; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D051799:Delayed Graft Function / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D004334:Drug Administration Schedule; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015994:Incidence; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; C512542:thymoglobulin