Daclizumab versus rabbit antithymocyte globulin in high-risk renal transplants : five-year follow-up of a randomized study

Autor: Georges Mourad, Peter Lang, Karl Martin Wissing, Pierre Merville, François Bayle, Rachel Hellemans, F. Berthoux, Jean-Paul Squifflet, Marc Hazzan, Christian Noel, Bernard Charpentier, Dominique Durand, Guy Touchard, M. Kessler, Daniel Abramowicz, Nacera Ouali
Přispěvatelé: Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Toulouse [Toulouse], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Aide à la Décision pour une Médecine Personnalisé - Laboratoire de Biostatistique, Epidémiologie et Recherche Clinique - EA 2415 (AIDMP), Université Montpellier 1 (UM1)-Université de Montpellier (UM), CHU Henri Mondor, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Hôpital Nord (Saint Etienne), Hôpital Pellegrin, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Universitaire [Grenoble] (CHU), Service de Néphrologie et Transplantation rénale [CHRU-lille], Basic (bio-) Medical Sciences
Jazyk: angličtina
Rok vydání: 2015
Předmět:
Graft Rejection
Male
Daclizumab
immunosuppressant
graft survival
kidney transplantation/nephrology
Kidney Function Tests
law.invention
Postoperative Complications
Randomized controlled trial
law
Risk Factors
Immunology and Allergy
Pharmacology (medical)
Prospective Studies
Prospective cohort study
Kidney transplantation
Panel reactive antibody
Middle Aged
renal transplantation
Prognosis
3. Good health
fusion proteins and monoclonal antibodies: basiliximab/daclizumab
Female
polyclonal preparations: rabbit antithymocyte globulin
Rabbits
Immunosuppressive Agents
medicine.drug
Glomerular Filtration Rate
Adult
medicine.medical_specialty
rabbit antihymocyte globulin
Urology
Renal function
[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery
Antibodies
Monoclonal
Humanized
clinical research/practice
medicine
Animals
Humans
Antilymphocyte Serum
Transplantation
Thymoglobulin
business.industry
medicine.disease
Kidney Transplantation
Surgery
Immunoglobulin G
Kidney Failure
Chronic
Human medicine
business
randomized study
Follow-Up Studies
Zdroj: American journal of transplantation
American Journal of Transplantation
American Journal of Transplantation, Wiley, 2015, 15 (7), pp.1923-32. ⟨10.1111/ajt.13191⟩
ISSN: 1600-6135
1600-6143
Popis: International audience; We previously reported a randomized controlled trial in which 227 de novo deceased-donor kidney transplant recipients were randomized to rabbit antithymocyte (rATG, Thymoglobulin) or daclizumab if they were considered to be at high immunological risk, defined as high panel reactive antibodies (PRA), loss of a first kidney graft through rejection within 2 years of transplantation, or third or fourth transplantation. Patients treated with rATG had lower incidences of biopsy-proven acute rejection (BPAR) and steroid-resistant rejection at 1 year. Patients were followed to 5 years posttransplant in an observational study; findings are described here. Treatment with rATG was associated with a lower rate of BPAR at 5 years (14.2% vs. 26.0% with daclizumab; p = 0.035). Only one rATG-treated patient (0.9%) and one daclizumab-treated patient (1.0%) developed BPAR after 1 year. Five-year graft and patient survival rates, and renal function, were similar between the two groups. Overall graft survival at 5 years was significantly higher in patients without BPAR (81.0% vs. 54.8%; p < 0.001). In conclusion, rATG is superior to daclizumab for the prevention of BPAR among high-immunological-risk renal transplant recipients. Overall graft survival at 5 years was approximately 70% with either induction therapy, which compares favorably to low-risk cohorts.
Databáze: OpenAIRE
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