Efficacy and Safety of ATG-Fresenius as an Induction Agent in Living-Donor Kidney Transplantation.
BACKGROUND
Induction therapy is mostly recommended for deceased-donor transplantation, whereas it has some controversies in live-donor transplantation. In this study, we described the outcomes of live-donor renal transplant recipients who received ATG-Fresenius (ATG-F) induction.


METHODS
Live-donor transplantations in patients over 18 years old with ATG-F induction between 2009 and 2015 were included. All patients received quadruple immunosuppression, one of which was ATG-F induction. Biopsies after the artery anastomosis (zero hour) and protocol biopsies at the 6th month and at the 1st first year were obtained. Acute graft dysfunction was defined as a 20% to 25% increase in creatinine level from baseline. All acute rejection episodes were biopsy-confirmed. All episodes were initially treated with intravenous methyl prednisolone (MP) or ATG-F if resistant to MP. Four hundred twenty-two patients with live-donor transplantation were evaluated. The mean age was 40 ± 13 (18-73) years. The mean panel-reactive antibody levels were 42% ± 30% and 45% ± 30% for class I and II, respectively.


RESULTS
The mean mismatch number for living unrelated donors (n = 112) was 4.6 ± 1.0. Acute rejection rate was 29.1% (123 patients) within the first year. The mean cumulative ATG-F doses for per patient and per kilogram were 344 ± 217 mg and 5.1 ± 2.7 mg, respectively. Patient survival rates were 98.3% and 96.7% for 12 months and 60 months, respectively. Death-censored graft survival rates were 97.6% and 92.1% for 12 months and 60 months, respectively.


CONCLUSIONS
ATG-F induction provided excellent graft and patient survival rates without any significantly increased side effects. Increasing sensitized patient numbers, more unrelated donors, increasing re-transplantation numbers, and more desensitization protocols make ATG-F more favorable in an induction regimen.
Ege University, School of Medicine, Department of Nephrology, Izmir, Turkey. Electronic address: mumt@hotmail.com.
M
M
Yilmaz
Ege University, School of Medicine, General Surgery, Izmir, Turkey.
T Ö
TÖ
Sezer
Ege University, School of Medicine, Department of Nephrology, Izmir, Turkey.
E
E
Günay
Ege University, School of Medicine, General Surgery, Izmir, Turkey.
I
I
Solak
Ege University, School of Medicine, Department of Nephrology, Izmir, Turkey.
A
A
Çeltik
Ege University, School of Medicine, General Surgery, Izmir, Turkey.
C
C
Hoşcoşkun
Ege University, School of Medicine, Department of Nephrology, Izmir, Turkey.
H
H
Töz
D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged
D007166:Immunosuppressive Agents