title: Safety and efficacy of induction treatment with low thymoglobulin doses in kidney transplantation from expanded-criteria donors.
abstract: BACKGROUND
  Induction treatment has been recommended as part of the initial immunosuppressive regimen in kidney transplantation, and antithymocyte globulin is one of the drugs used for it, but at usual dosage it has been related to an increase of infectious and neoplastic complications. Our aim was to analyze the safety and efficacy of induction treatment with low doses of antithymocyte globulin, compared to basiliximab.
  
  
  METHODS
  In this retrospective cohort study of 321 kidney transplant patients with a minimum follow-up of 2 years, 162 were treated with low doses of antithymocyte globulin (1.25 mg/kg, every other day) and 159 with basiliximab. Mean follow-up was 76.6 ± 37.51 months (range, 24-187 mo) and was similar for the 2 groups.
  
  
  RESULTS
  Mean number of antithymocyte globulin doses was 1.89 ± 0.32 mg/kg (range, 1-3). The globulin group received a higher proportion of kidneys from donors >70 years old (25.3% vs 13.8%; P = .010) and donors with higher creatinine levels (1.01 ± 0.62 vs 0.86 ± 0.28 mg/dL; P = .006). The basiliximab group presented a higher incidence of acute rejection (22.1% vs 9.1%; P = .010). Cytomegalovirus disease was more frequent in the globulin group (18.6% vs 8.1%; P = .011) without an increase of infectious hospitalizations. Graft (P = .214) and patient (P = .533) survivals were similar.
  
  
  CONCLUSIONS
  Induction with low doses of antithymocyte globulin resulted in a lower incidence of acute rejection with graft and patient survivals similar to that obtained with basiliximab induction, in spite of a worse donor profile. CMV disease was more frequent with antithymocyte globulin, without an increase of infectious hospitalizations or cancer development, in long-term follow-up.
authors: Hospital Universitario Dr Peset, Valencia, Spain. Electronic address: asanchoc2@gmail.com.
authors: A
authors: A
authors: Sancho Calabuig
authors: Hospital Universitario Dr Peset, Valencia, Spain.
authors: E
authors: E
authors: Gavela Martínez
authors: Hospital Universitario Dr Peset, Valencia, Spain.
authors: J
authors: J
authors: Kanter Berga
authors: Hospital Universitario Dr Peset, Valencia, Spain.
authors: S
authors: S
authors: Beltrán Calatán
authors: Hospital Universitario Dr Peset, Valencia, Spain.
authors: A I
authors: AI
authors: Avila Bernabeu
authors: Hospital Universitario Dr Peset, Valencia, Spain.
authors: L M
authors: LM
authors: Pallardó Mateu
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D000077552:Basiliximab; D002648:Child; D002675:Child, Preschool; D046148:Donor Selection; D004305:Dose-Response Relationship, Drug; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology* / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab; C512542:thymoglobulin