title: Clinical experience with induction therapy in renal transplantation.
abstract: BACKGROUND
  Acute rejection (AR) is a major determinant of renal allograft survival. The incorporation of new immunosuppressive agents explains the improvement seen in the results of transplantation in recent years.
  
  
  OBJECTIVE
  To assess the optimal immunosuppression regimen according to the immunological risk of renal transplant patients.
  
  
  METHODS
  We performed a retrospective study of 977 consecutive patients transplanted in our institution between January 2000 and December 2011. Recipients were classified according to the immunological risk (high, intermediate and low) and the type of induction therapy received. We evaluated the incidence of early acute rejection (eAR) and late acute rejection (lAR) and their influence on graft and patients survival in relation to the immunological risk and induction regimen used.
  
  
  RESULTS
  The incidence of eAR was 5.4%, 6.4% and 1.4% in relation with the immunological risk, high, intermediate and low respectively. The most commonly used induction immunosuppression was rabbit antithymocyte globulin (ATG), followed by methylprednisolone and basiliximab. No statistical difference was found between the incidence of eAR according to the type of induction therapy and immunological risk. The graft survival was significantly better for the cases without eAR at 1 year (98.6% versus 94.4%, p=0.019), and 3 years (94.9% versus 88.9%, p=0.056). The patients survival was significantly better for those without eAR at 1 year after transplant (95.7% vs. 88.9%, p=0.051), 3 years (93.1% vs. 83.3%, p=0.008) and 5 years (92.2% vs. 79.6%, p=0.001). The incidence of lAR was between 0 and 7.1% according to the induction therapy, lacking any statistical significance (p=0.450).
  
  
  CONCLUSIONS
  Tailoring the induction immunosuppression according to the immunological risk reduces the incidence of early acute rejection.
authors.affiliation: Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania.
authors.forename: Adriana
authors.initials: A
authors.lastname: Muntean
authors.affiliation: Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania.
authors.forename: Mihai
authors.initials: M
authors.lastname: Lucan
authors.affiliation: Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania.
authors.forename: Adrian
authors.initials: A
authors.lastname: Barbos
authors.affiliation: Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania.
authors.forename: Alina
authors.initials: A
authors.lastname: Elec
authors.affiliation: Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania.
authors.forename: Gheorghita
authors.initials: G
authors.lastname: Iacob
authors.affiliation: Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania.
authors.forename: Luminita
authors.initials: L
authors.lastname: Loga
authors.affiliation: Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania.
authors.forename: Lucia
authors.initials: L
authors.lastname: Dican
keywords: acute rejection; induction therapy; renal transplantation