Low-dose Thymoglobulin vs Basiliximab Induction Therapy in Low-Risk Living Related Kidney Transplant Recipients: A Prospective Randomized Trial.

Autor: Martinez-Mier G; Department of Organ Transplantation, IMSS UMAE Hospital de Especialidades 14 Adolfo Ruiz Cortines, Veracruz, Mexico. Electronic address: gmtzmier@hotmail.com., Moreno-Ley PI; Department of Organ Transplantation, IMSS UMAE Hospital de Especialidades 14 Adolfo Ruiz Cortines, Veracruz, Mexico., Budar-Fernández LF; Department of Organ Transplantation, IMSS UMAE Hospital de Especialidades 14 Adolfo Ruiz Cortines, Veracruz, Mexico., Méndez-López MT; Department of Organ Transplantation, IMSS UMAE Hospital de Especialidades 14 Adolfo Ruiz Cortines, Veracruz, Mexico., Allende-Castellanos CA; Department of Organ Transplantation, IMSS UMAE Hospital de Especialidades 14 Adolfo Ruiz Cortines, Veracruz, Mexico., Jiménez-López LA; Department of Organ Transplantation, IMSS UMAE Hospital de Especialidades 14 Adolfo Ruiz Cortines, Veracruz, Mexico., Barrera-Amoros DA; Department of Organ Transplantation, IMSS UMAE Hospital de Especialidades 14 Adolfo Ruiz Cortines, Veracruz, Mexico., Aguilar-Sandoval E; Department of Organ Transplantation, IMSS UMAE Hospital de Especialidades 14 Adolfo Ruiz Cortines, Veracruz, Mexico., De la Paz-Román M; Department of Organ Transplantation, IMSS UMAE Hospital de Especialidades 14 Adolfo Ruiz Cortines, Veracruz, Mexico., Soto-Miranda E; Department of Organ Transplantation, IMSS UMAE Hospital de Especialidades 14 Adolfo Ruiz Cortines, Veracruz, Mexico., Rivera-Sanchez Y; School of Medicine, Universidad del Valle de México-Universidad Villa Rica, Veracruz, México., Martínez-Maldonado M; School of Medicine, Universidad del Valle de México-Universidad Villa Rica, Veracruz, México.
Jazyk: angličtina
Zdroj: Transplantation proceedings [Transplant Proc] 2021 Apr; Vol. 53 (3), pp. 1005-1009. Date of Electronic Publication: 2020 Mar 13.
DOI: 10.1016/j.transproceed.2020.01.054
Abstrakt: Context: Thymoglobulin is used effectively as induction agent in kidney transplantation but the optimal dose is not well established.
Objective: Demonstrate that low-dose thymoglobulin (3 mg/kg) has similar efficacy and safety compared to basiliximab induction in low-risk kidney transplantation under standard maintenance immunosuppression DESIGN, SETTING, PARTICIPANTS: Prospective randomized study in kidney transplant patients (12/2016-05/2018).
Inclusion Criteria: Recipients > 18 years, first living donor transplant.
Exclusion Criteria: Second and multiorgan transplant, ABO incompatibility, positive cross-match, panel reactive antibodies (PRA) > 30%, positive donor-specific antibody, human immunodeficiency virus, hepatitis B surface antigen, hepatitis C virus positive, white blood cells < 2000 cells/mm 3 , platelets < 75,000 cells/mm 3 and malignancy.
Intervention: Group A: basiliximab (20 mg D0 and D4). Group B: thymoglobulin (3 mg/kg total). Maintenance immunosuppression: tacrolimus, mycophenolate mofetil, and steroids.
Main Outcome Measures: Biopsy-proven acute rejection (BPAR), delayed graft function, slow graft function, leukopenia, infections, adverse events, graft loss, estimated glomerular filtration rate, and death within 12 months.
Results: 100 patients (basiliximab, n = 53) (thymoglobulin, n = 47) were included. Donor and recipient characteristics were similar except for longer dialysis (basiliximab), PRA class I (1.2% basiliximab, 4.5% thymoglobulin), HLA match (basiliximab 2.8, thymoglobulin 2.2), and cytomegalovirus status. BPAR rate was basiliximab 3.8% and thymoglobulin 6.4% (P = ns). Delayed graft function (basiliximab 3.8%; thymoglobulin 4.3%), slow graft function, and 12-month leukopenia (basiliximab 11.3%, thymoglobulin 21.3%) were similar between groups (P = ns). There was no difference in infections and adverse events between groups. Patient and graft survival were as follows: basiliximab 98.1% and 92.5%, thymoglobulin 100% and 93.6% (P = ns).
Conclusion: Low-dose thymoglobulin induction (3 mg/kg) can be used effectively and safely in low-risk kidney transplantation with good results during the first year post-transplant.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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