Comparison of Induction Therapy Using Antithymocyte Globulin and Using Basiliximab for Live Donor Kidney Transplant Recipients: A Single Centre Prospective Cohort Study
DOI:
https://doi.org/10.22159/ajpcr.2016.v9i6.14099Abstract
Objective: Acute rejections (AR) have a negative impact on long-term graft survival and are the major predictor of chronic rejection. Induction therapy is used to reduce AR and prevent delayed graft function (DGF). Antithymocyte globulin (ATG) and basiliximab are mainly used for this purpose. In this prospective, cohort study, we analysed and compared the safety and efficacy of ATG and basiliximab in induction therapy for live donor kidney transplant recipients.
Methods: Graft survival, AR-free survival, renal function, DGF and tolerability were compared in patients who underwent live-donor transplantation between January 2014 and August 2014 at Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
Results and Discussion: A total of 85 live-donor kidney transplant recipients who enrolled were followed up for 12 mo. The incidence of AR was greater in the basiliximab group, as compared with the ATG group (25.6% versus 7.1%, p <0.05). The incidence of antibody treated AR was also greater (18.6% versus 2.4 %, p < 0.05). Patient survival rate and graft survival rate were 95.2% and 92.9% in the ATG group, respectively, compared with 90.4%and 90.7% in the basiliximab group, respectively. The incidence of adverse events was higher in the ATG group compared with the basiliximab group (71.4% versus 48.3%, p<0.05).
Conclusion: The incidence of AR and antibody-treated AR was significantly higher in the basiliximab group than in the ATG cohort. However, ATG was associated with significantly higher incidence of adverse events and leucopenia than basiliximab. Both the strategies were achieved similar patient and graft survival.
Downloads
References
Cecka JM, Cho YW, Terasaki PI. Analyses of the UNOS scientific renal transplant registry at three years - Early events affecting transplant success. Transplantation 1992;53(1):59-64.
Hariharan S, Johnson CP, Bresnahan BA, Taranto SE, McIntosh MJ, Stablein D. Improved graft survival after renal transplantation in the United States, 1988 to 1996. N Engl J Med 2000;342(9):605-12.
Lebranchua Y, Bridouxb F, Büchlera M, Le Meurc Y, Etienned I, Toupance O, et al. Immunoprophylaxis with basiliximab compared with antithymocyte globulin in renal transplant patients receiving MMF - Containing triple therapy. Am J Transplant 2002;2:48-56.
Kupiec-Weglinski JW, Diamantstein T, Tilney NL. Interleukin 2 receptor-targeted therapy - Rationale and applications in organ transplantation. Transplantation 1988;46(6):785-92.
Hariharan S. Long-term kidney transplant survival. Am J Kidney Dis 2001;38 6 Suppl 6:S44-50.
Matas AJ, Smith JM, Skeans MA, Thompson B, Gustafson SK, Stewart DE, et al. OPTN/SRTR 2013 Annual Data Report: Kidney. Am J Transplant 2015;15 Suppl 2:1-34.
Soulillou JP, Cantarovich D, Le Mauff B, Giral M, Robillard N, Hourmant M, et al. Randomized controlled trial of a monoclonal antibody against the interleukin-2 receptor (33B3.1) as compared with rabbit antithymocyte globulin for prophylaxis against rejection of renal
allografts. N Engl J Med 1990;322(17):1175-82.
Amlot PL, Rawlings E, Fernando ON, Griffin PJ, Heinrich G, Schreier MH, et al. Prolonged action of a chimeric interleukin-2 receptor (CD25) monoclonal antibody used in cadaveric renal transplantation. Transplantation 1995;60(7):748-56.
Brennan DC, Flavin K, Lowell JA, Howard TK, Shenoy S, Burgess S, et al. A randomized, double-blinded comparison of Thymoglobulin versus atgam for induction immunosuppressive therapy in adult renal transplant recipients. Transplantation 1999;67(7):1011-8.
Meier-Kriesche HU, Arndorfer JA, Kaplan B. Association of antibody induction with short- and long-term cause-specific mortality in renal transplant recipients. J Am Soc Nephrol 2002;13(3):769-72.
Mourad G, Rostaing L, Legendre C, Garrigue V, Thervet E, Durand D. Sequential protocols using basiliximab versus antithymocyte globulins in renal-transplant patients receiving mycophenolate mofetil and steroids. Transplantation 2004;78(4):584-90.
Levey AS, Schmid CH, Lau J. Antilymphocyte antibodies, renal trans plantation, and meta-analysis. Ann Intern Med 1998;128:863-5.
Meier-Kriesche HU, Ojo AO, Hanson JA, Cibrik DM, Punch JD, Leichtman AB, et al. Increased impact of acute rejection on chronic allograft failure in recent era. Transplantation 2000;70(7):1098-100.
Vanrenterghem Y, Lebranchu Y, Hené R, Oppenheimer F, Ekberg H. Double-blind comparison of two corticosteroid regimens plus mycophenolate mofetil and cyclosporine for prevention of acute renal allograft rejection. Transplantation 2000;70(9):1352-9.
Mourad G, Garrigue V, Squifflet JP, Besse T, Berthoux F, Alamartine E, et al. Induction versus noninduction in renal transplant recipients with tacrolimus-based immunosuppression. Transplantation 2001;72(6):1050-5.
Nashan B, Moore R, Amlot P, Schmidt AG, Abeywickrama K, Soulillou JP. Randomised trial of basiliximab versus placebo for control of acute cellular rejection in renal allograft recipients. CHIB 201 International Study Group. Lancet 1997;350(9086):1193-8.
Kahan BD, Rajagopalan PR, Hall M. Reduction of the occurrence of acute cellular rejection among renal allograft recipients treated with basiliximab, a chimeric anti-interleukin-2-receptor monoclonal antibody. United States Simulect Renal Study Group. Transplantation 1999;67(2):276-84.
Brennan DC, Daller JA, Lake KD, Cibrik D, Del Castillo D; Thymoglobulin Induction Study Group. Rabbit antithymocyte globulin versus basiliximab in renal transplantation. N Engl J Med 2006;355(19):1967-77.
Libório AB, Mendoza TR, Esmeraldo RM, Oliveira ML, Paes FJ, Silva GB Jr, et al. Induction antibody therapy in renal transplantation using early steroid withdrawal: Long-term results comparing anti-IL2 receptor and anti-thymocyte globulin. Int Immunol 2011;11:1832-6.
Yang S, Wang D, Wu W, Lin WH, Xu TZ, Cai JQ, et al. Comparison of single bolus ATG and Basiliximab as induction therapy in presensitized renal allograft recipients receiving tacrolimus-based immunosuppressive regimen. Transpl Immunol 2008;18:281-5.
Ducloux D, Kazory A, Challier B, Coutet J, Bresson-Vautrin C, Motte G, et al. Long-term toxicity of antithymocyte globulin induction may vary with choice of agent: A single-center retrospective study. Transplantation 2004;77(7):1029-33.
Kaden J, May G, Strobelt V, Groth J, Müller P. Intraoperative T-cell depletion prior to completion of anastomoses by high-dose single ATG bolus as a new approach to improve long-term results after kidney transplantation. Transplant Proc 1997;29(1-2):344-7.
Nampoory MR, Abdulhalim M, Johny KV, Al-Jawad Donia FA, Nair MP, Said T, et al. Bolus anti-thymocyte globulin induction in renal transplant recipients: A comparison with conventional ATG or anti-interleukin-2 receptor antibody induction. Transplant Proc 2002;34(7):2916-9.
Tullius SG, Pratschke J, Strobelt V, Kahl A, Reinke P, May G, et al. ATG versus basiliximab induction therapy in renal allograft recipients receiving a dual immunosuppressive regimen: One-year results. Transplant Proc 2003;35(6):2100-1.
Published
How to Cite
Issue
Section
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.