Induction With Basiliximab Plus Thymoglobulin Is Effective and Safe in Old-for-Old Renal Transplantation: Six-Month Results of a Prospective Clinical Study

• Published in: Transplantation proceedings Vol. 42; no. 4; pp. 1114 - 1117
• Main Authors: Favi, E, Gargiulo, A, Spagnoletti, G, Salerno, M.P, Silvestrini, N, Valente, I, Citterio, F
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 01.05.2010; Elsevier
• Subjects: Adult; Aged; Antibodies, Monoclonal - therapeutic use; Antilymphocyte Serum - therapeutic use; Biological and medical sciences; Creatinine - blood; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Survival - immunology; Humans; Immunosuppressive Agents - therapeutic use; Kidney Transplantation - immunology; Kidney Transplantation - physiology; Male; Medical sciences; Middle Aged; Prospective Studies; Recombinant Fusion Proteins - therapeutic use; Renal Dialysis; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tissue Donors - statistics & numerical data; Tissue, organ and graft immunology; Drug combination; Induction; Monoclonal antibody; Homotransplantation; Kidney; Result; Immunomodulator; Medicine; Prospective; Symptomatology; Treatment; Urinary system; Efficiency; Surgery; Basiliximab; Immunotherapy; Graft; Immunosuppressive agent; Triggering; Antithymocyte globulin; Kidney transplantation
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2010.03.073

Abstract Old-for-old renal transplantation is becoming more frequent, but the optimal immunosuppressive regimens for this transplant population are still unclear. The aim of this pilot prospective study was to evaluate the efficacy and safety of the combination of basiliximab with a short course of low-dose thymoglobulin induction therapy among a group of patients receiving kidneys from donors >60 years (OLD), compared with those receiving organs from donors <60 years (YNG). Forty-six consecutive deceased donor kidney transplant patients received induction therapy with a combination of basiliximab (20 mg IV on days 0 and 4) and thymoglobulin (200 mg total dose IV on days 0–3). As maintenance immunosuppression starting on day 4, patients received a low dose of calcineurin inhibitor and steroids. Demographic characteristics at baseline were not significantly different between the 2 groups. At 6 months, patient survival, graft survival, and acute rejection rates were similar between the YNG and OLD groups: 100% and 95%, 96% and 95%, and 8% and 0%, respectively. Patients in the OLD group showed higher serum creatinine concentrations (YNG 1.5 ± 0.3 vs OLD 1.9 ± 0.3 mg/dL; P = .0002) but not proteinuria (YNG 0.11 ± 0.11 vs OLD 0.15 ± 0.14 g/24 h; P = ns). No significant difference was evident between the 2 groups regarding infectious, hematologic, or posttransplantation lymphoproliferative disorder complications. This study showed that a combination of basiliximab and a short course of low-dose thymoglobulin provided effective and safe immunosuppression, in old-for-old renal transplantation, with good renal function without an increased risk of posttransplantation infectious or hematologic complications.