Efficacy and safety of single and multiple dose antithymocyte globulin induction treatment in living related renal transplantation

IntroductionThe aim of the study was to compare the safety and efficacy of two regimens of induction therapy with antithymocyte globulin (ATG)-Fresenius in living related renal transplant recipients.MethodsEighty-seven patients were allocated into group 1 receiving single dose ATG (9 mg/kg b.w., 15 patients), group 2, multiple dose ATG (9 mg/kg b.w. intraoperatively plus 3 mg/kg b.w. for the next 4 days, 53 patients), group 3 on triple immunosuppression alone (20 patients). Maintenance immunosuppression consisted of cyclosporine (CsA) or tacrolimus (Tac), mycophenolate mofetil, corticosteroids.ResultsDemographic data was similar for all groups. In comparison to groups 1 and 2, patients from group 3 had lower immunologic risk, although insignificant. One patient: 6.6% from group 1; nine: 16.9% from group 2; and three: 15% from group 3 exhibited acute rejection (AR) and five patients: one from group 1, and three from group 2 delayed graft function (DGF). Mean creatinine clearance differed insignificantly between the groups during the follow-up period. Multiple dose ATG therapy was associated with leucopenia (six patients) and more frequent infections (group 1 vs 2: P = 0.03).ConclusionIn kidney graft recipients without history of prior kidney transplantation or peak PRA lower than 50% single dose, ATG is as safe and equally efficient as multiple ATG doses in the prevention of AR and DGF but the same efficacy was achieved with triple immunosuppression.