title: Evaluating safety and efficacy of rabbit antithymocyte globulin induction in elderly kidney transplant recipients.
abstract: OBJECTIVE
  The optimal immunosuppression regimen for elderly kidney transplant recipients is poorly defined. We sought to evaluate the short-term efficacy and safety of thymoglobulin in geriatric recipients of deceased-donor kidneys.
  
  
  METHODS
  A single-center, retrospective analysis was undertaken between elderly (≥ 65 years) (n=137) and nonelderly (n=276) kidney transplant recipients who received rabbit antithymocyte globulin induction and calcineurin inhibitor, mycophenolic acid, and prednisone maintenance.
  
  
  RESULTS
  The mean age was 70 versus 52 years. Fewer elderly patients had an earlier transplant or panel reactive antibodies > 20%, but had more machine perfused, older, and extended criteria donor kidneys. Elderly patients received lower rabbit antithymocyte globulin (5.4 vs 5.6 mg/kg; P = .04) and initial mycophenolic acid doses (1620 vs 1774 mg; P = .002), and experienced less delayed graft function (31.1% vs 50.0%; P < .001). Death-censored graft survival and graft function at 3 years and biopsy-proven acute rejection at 1 year were comparable; however, there was lower 3-year patient survival in elderly patients. Donor age was the only factor associated with reduced patient survival. Rates of malignancy, infection, or thrombocytopenia were similar; however, leukopenia occurred less frequently in elderly patients (11.7% vs 19.9%; P = .038).
  
  
  CONCLUSIONS
  Elderly kidney transplant recipients receiving rabbit antithymocyte globulin did not experience different short-term graft survival, graft function or rates of infection, malignancy or hematologic adverse reactions than did nonelderly patients; they experienced fewer episodes of delayed graft function, but had lower 3-year patient survival.
authors: Department of Surgery, Einstein Medical Center, Philadelphia, PA, USA. khanmok@einstein.edu
authors: Kamran
authors: K
authors: Khanmoradi
authors: John P
authors: JP
authors: Knorr
authors: Eyob L
authors: EL
authors: Feyssa
authors: Afshin
authors: A
authors: Parsikia
authors: Pankaj
authors: P
authors: Jawa
authors: Duy-Bao
authors: DB
authors: Dinh
authors: Stalin
authors: S
authors: Campos
authors: Radi F
authors: RF
authors: Zaki
authors: Jorge A
authors: JA
authors: Ortiz
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000818:Animals; D000961:Antilymphocyte Serum / Q000008:administration & dosage* / Q000009:adverse effects; D016009:Chi-Square Distribution; D016572:Cyclosporine / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage; D018579:Patient Selection; D015143:Philadelphia; D011241:Prednisone / Q000008:administration & dosage; D016016:Proportional Hazards Models; D011817:Rabbits; D012189:Retrospective Studies; D012307:Risk Factors; D016559:Tacrolimus / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid; D011241:Prednisone; D016559:Tacrolimus