title: Effect of induction therapy in kidney transplantation in sensitive patients: analysis of risks and benefits.
abstract: BACKGROUND
  Sensitization is associated with worse clinical outcomes after kidney transplantation (KT), including increased incidence of delayed graft function, acute rejection (AR) and graft loss.
  
  
  OBJECTIVE
  To evaluate 1-year efficacy and safety outcomes in sensitized KT recipients receiving antithymocyte globulin (ATG) induction and compare them to non-sensitized patients.
  
  
  METHODS
  Deceased donors KT recipients transplanted between January 1998 and December 2009 were divided into 5 groups: control group 1 -n = 89, PRA negative, without induction therapy; control group 2 - n = 94, PRA negative, basiliximab induction; control group 3 - n = 81, PRA negative, ATG induction; test group 4 - n = 64, PRA 1-49%, ATG induction; test group 5 -n = 118, PRA ≥ 50%, ATG induction.
  
  
  RESULTS
  There was no difference in the incidence of AR among patients sensitized and non-sensitized, except for group 1, with highest incidence of AR (20.2%,p = 0.006 vs. Group 4 and p = 0.001 vs. group 5). Sensitized patients induced with ATG had higher incidence of citomegalovirus infection when compared with group 2 (26.6% and 14.4% vs. 2.1%). There were no differences in graft and patient survivals. In multivariable analysis, PRA > 50% and ATG induction were not associated with graft loss, death or death-censored graft loss.
  
  
  CONCLUSIONS
  Sensitized patients induced with ATG presented similar or lower incidence of AR when compared with non-sensitized patients not induced. Besides, these patients had similar safety profile and graft and patient survivals at 1 year.
authors.affiliation: Hospital do Rim, Brazil.
authors.forename: Marcela Portugal de Alencar
authors.initials: MP
authors.lastname: Ribeiro
authors.affiliation: Hospital do Rim, Brazil.
authors.forename: Tainá Veras de
authors.initials: TV
authors.lastname: Sandes-Freitas
authors.affiliation: Hospital do Rim, Brazil.
authors.forename: Kelly Harada
authors.initials: KH
authors.lastname: Sato
authors.affiliation: Hospital do Rim, Brazil.
authors.forename: Marcio Assis
authors.initials: MA
authors.lastname: Ribeiro Junior
authors.affiliation: Hospital do Rim, Brazil.
authors.forename: Helio Tedesco
authors.initials: HT
authors.lastname: Silva-Junior
authors.affiliation: Hospital do Rim, Brazil.
authors.forename: Jose Osmar
authors.initials: JO
authors.lastname: Medina-Pestana
mesh_terms: D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents