title: Polyclonal versus monoclonal induction therapy in a calcineurin inhibitor-free immunosuppressive therapy in renal transplantation: a comparison of efficacy and costs.
abstract: BACKGROUND
  Induction therapy in renal transplantation reduces the incidence of acute rejection (AR) in expanded criteria donation (ECD) and donation after cardiac death (DCD). We compared the efficacy of Thymoglobulin (Sanofi-Aventis, Spain), ATG Fresenius (ATG-Fresenius, Spain), and Simulect (Novartis Farm, Spain) in a calcineurin-free protocol in ECD and DCD renal transplantation by evaluating patient survival, graft survival, and AR at 1 year and overall costs.
  
  
  METHODS
  An observational retrospective study was performed using our database of 289 consecutive cadaveric ECD renal transplant recipients (n = 178) and DCD recipients (n = 111) from April 1999 to December 2011. Induction therapy consisted of Simulect, Thymoglobulin, and ATG Fresenius. Calcineurin-inhibitor (CNI)-free maintenance therapy consisted of mycophenolate mofetil or sodium and steroids.
  
  
  RESULTS
  There were no differences in the patients' demographic characteristics or patient and graft survival. One-year AR rates were equivalent (ECD: 10%, 19.1%, 17.7% versus DCD: 14.3%, 7.1%, 16.7%). Leukopenia and thrombopenia were significantly more frequent in the ECD group treated with polyclonal induction. The average total cost of transplantation was higher in the ECD group but there were no significant differences in the average total cost between ECD and DCD: 39,970.31 ± 7,732€ versus 35,058.34 ± 6,801€ (P = NS).
  
  
  CONCLUSIONS
  Our study shows the same efficacy with polyclonal and monoclonal antibody induction and a CNI-free treatment regimen in ECD and DCD renal transplantation with no differences in overall costs at 1 year after transplantation.
authors: Nephrology and Renal Transplant Department, Hospital Clinic, Barcelona, Spain. Electronic address: asanchee@clinic.ub.es.
authors: A
authors: A
authors: Sánchez-Escuredo
authors: Economic Nephrology Department, Hospital Clinic, Barcelona, Spain.
authors: A
authors: A
authors: Alsina
authors: Nephrology and Renal Transplant Department, Hospital Clinic, Barcelona, Spain.
authors: F
authors: F
authors: Diekmann
authors: Nephrology and Renal Transplant Department, Hospital Clinic, Barcelona, Spain.
authors: I
authors: I
authors: Revuelta
authors: Nephrology and Renal Transplant Department, Hospital Clinic, Barcelona, Spain.
authors: N
authors: N
authors: Esforzado
authors: Nephrology and Renal Transplant Department, Hospital Clinic, Barcelona, Spain.
authors: M J
authors: MJ
authors: Ricart
authors: Nephrology and Renal Transplant Department, Hospital Clinic, Barcelona, Spain.
authors: F
authors: F
authors: Cofan
authors: Economic Nephrology Department, Hospital Clinic, Barcelona, Spain.
authors: E
authors: E
authors: Fernandez
authors: Nephrology and Renal Transplant Department, Hospital Clinic, Barcelona, Spain.
authors: J M
authors: JM
authors: Campistol
authors: Nephrology and Renal Transplant Department, Hospital Clinic, Barcelona, Spain.
authors: F
authors: F
authors: Oppenheimer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use*; D000961:Antilymphocyte Serum / Q000191:economics / Q000627:therapeutic use*; D000077552:Basiliximab; D019703:Calcineurin; D065095:Calcineurin Inhibitors; D003362:Cost-Benefit Analysis; D003643:Death; D046148:Donor Selection; D005260:Female; D006084:Graft Rejection / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000191:economics*; D007166:Immunosuppressive Agents / Q000191:economics / Q000627:therapeutic use*; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000191:economics / Q000401:mortality / Q000601:surgery; D016030:Kidney Transplantation / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000191:economics / Q000627:therapeutic use*; D012189:Retrospective Studies; D013030:Spain; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D013256:Steroids; D000077552:Basiliximab; C512542:thymoglobulin; D019703:Calcineurin; D009173:Mycophenolic Acid