Nephrology Dialysis Transplantation, Vol 13, Issue 3 711-715, Copyright © 1998 by Oxford University Press
D Thibaudin, E Alamartine, J de Filippis, N Diab, B Laurent and F Berthoux
Background: Sensitized kidney allograft recipients
require special management to improve their outcome. One strategy is heavy
immunosuppression with antilymphocyte antibodies. Controversy continues
about the actual advantage of induction protocols whilst infections and
cancers are a constant risk. In addition, little is known about how to
handle sensitized patients with low levels of sensitization.
Methods: In this study we randomized sensitized renal
transplant recipients, who received prophylactic treatment with or without
antithymocyte globulin (ATG), in addition to a standard triple regimen
consisting of cyclosporin, steroids and azathioprine at ATG
discontinuation. The induction treatment consisted of a low-dose ATG course
over 10 days. Randomization was stratified on the maximum PRA, according to
the five following classes: 5%<PRA⩽20%,
20%<PRA⩽40%, 40%<PRA⩽60%,
60%<PRA;⩽80% and 80%<PRA⩽100%.
Results: Eighty nine patients were enrolled: 47
patients received ATG and 42 did not. ATG induction lowered the incidence
of biopsy-proven acute rejection episodes from 64 to 38%, increased 1 year
graft survival from 76 to 89% and was associated with a higher 1 year
inulin clearance (37±15 vs 49±18
ml/min). ATG-associated side effects were restricted to leucopenia and
thrombocytopenia, whereas bacterial and viral infections, gammopathies and
cancers did not occur more frequently. ATG induction benefited all
sensitized patients, and not only the hypersensitized patients.
Conclusions: We conclude that ATG induction is
beneficial for all sensitized patients, regardless of their level of
sensitization, with regard to acute rejection episodes, graft survival and
graft function. Low-dose ATG is sufficient and prevents additional
complications. Key words: antithymocyte globulin;
immunosuppression; induction therapy; renal transplantation; triple therapy
ORIGINAL ARTICLES
Advantage of antithymocyte globulin induction in sensitized kidney recipients: a randomized prospective study comparing induction with and without antithymocyte globulin
Service de Nephrologie Dialyse Transplantation Renale, Hopital Nord, F-42055 Saint-Etienne cedex 2, France; Corresponding author
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