The appropriate dose of thymoglobulin induction therapy in kidney transplantation

• Published in: Clinical transplantation Vol. 31; no. 6
• Main Authors: Nafar, Mohsen, Dalili, Nooshin, Poor‐Reza‐Gholi, Fatemeh, Ahmadpoor, Pedram, Samadian, Fariba, Samavat, Shiva
• Format: Journal Article
• Language: English
• Published: Denmark 01.06.2017
• Subjects: antibody‐mediated rejection; Antilymphocyte Serum - administration & dosage; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Graft Rejection - etiology; Graft Rejection - prevention & control; Graft Survival - drug effects; Humans; immune/inflammatory kidney disease; Immunosuppressive Agents - administration & dosage; Kidney Failure, Chronic - surgery; kidney failure/injury; Kidney Function Tests; Kidney Transplantation - adverse effects; living donor; Male; Middle Aged; Postoperative Complications - prevention & control; Prognosis; Remission Induction; Risk Factors; T cell mediated rejection; T cell mediated rejection; living donor; immune/inflammatory kidney disease; antibody-mediated rejection; kidney failure/injury
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.12977

Background Thymoglobulin is used effectively as an induction agent in kidney transplantation, but there is no consensus on the optimal dose. In order to delineate the safest effective dose, an open‐labeled randomized clinical trial was designed. Methods In this study, 90 adult kidney transplant recipients (KTR) were randomized before transplantation in three groups to receive thymoglobulin: Arm A (4.5 mg/kg in 3 days), Arm B (4.5 mg/kg single bolus dose), and Arm C (6 mg/kg in 3 days). Renal function, infections, and rate of readmissions were evaluated during the first post transplantation year. Results Ninety adult kidney recipients were enrolled (51% deceased donor). No significant statistical difference was found in acute rejection episodes or type of rejection between these groups, although patients in Arm A showed more severe histopathologic changes according to Banff 2013 criteria, in renal biopsies (P=.03). At the first month after transplantation serum Cr was lower (P=.001) and GFR was higher (P=.04) in Arm A, but there was no significant difference among the three groups at 3, 6, and 12 months post‐transplant. Conclusion Although all regimens showed the same efficacy regarding the rate of rejection episodes, 3‐day 4.5 mg/kg Thymoglobulin had significantly fewer complications.