Low-Dose Thymoglobulin as Effective as Basiliximab in Promoting Graft Survival and Preventing Acute Rejection in Kidney Transplant Recipients: Presented at ATC

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Title: Low-Dose Thymoglobulin as Effective as Basiliximab in Promoting Graft Survival and Preventing Acute Rejection in Kidney Transplant Recipients: Presented at ATC
URL: http://www.pslgroup.com/dg/2231FA.htm
Doctor's Guide
June 6, 2008

By Thomas S. May

TORONTO -- June 6, 2008 -- Induction therapy using low-dose thymoglobulin may be as effective as induction therapy using the monoclonal antibody basiliximab in promoting graft survival and preventing acute rejection in renal transplant recipients.

Recent reports have indicated that the use of full-dose thymoglobulin (7-10 mg/kg) was associated with high rates of infection and cancer in transplant patients.

Therefore, Mark Reza Laftavi, MD, Department of Surgery, State University of New York, University at Buffalo, Buffalo, New York, and colleagues performed a retrospective study that compared the efficacy and safety of low-dose thymoglobulin induction therapy with that of basiliximab induction therapy.

The study was presented in a poster session on June 1 here at the 2008 American Transplant Congress (ATC).

Between 2000 and 2007, the researchers randomised 355 kidney transplant recipients to induction treatment with thymoglobulin 3 to 5 mg/kg and 93 patients to treatment with basiliximab 20 mg 4 days apart. Both groups received equal triple immunosuppression therapy consisting of a calcineurin inhibitor, mycophenolate mofetil (MMF), and low-dose prednisone.

The 2 treatment arms were matched for baseline demographic data, including sex, donor type, age, and race. Mean cold ischaemia time was longer in the thymoglobulin group (15 vs 13 hours, P = .04). The 2 groups had similar duration of hospital stay (thymoglobulin 8.3 vs basiliximab 7.6 days, P = .44) and delayed graft function (28% vs 26%, respectively, P = .49).

Results showed 43 deaths in the thymoglobulin group and 14 in the basiliximab group (P = .44). Six patients died from infection/sepsis in the thymoglobulin group compared with 1 in the basiliximab group (P = .67).

All deaths due to infection occurred after 4 months post-transplant and 80% occurred after 2 years. Acute graft rejection occurred in 11% and 13%, respectively (P = .6). Graft loss (death censored) occurred in 43 patients in the thymoglobulin group and 9 patients in the basiliximab group (P = .51).

Based on these results the researchers concluded that low-dose thymoglobulin and basiliximab were equally effective in promoting graft survival and preventing acute rejection. They also noted that there was no increased risk of death, infection, or cancer in the low-dose thymoglobulin group.

"Our study showed that low-dose thymoglobulin is effective and does not increase the risk of infection or cancer," said Dr. Laftavi.

He added that many centres still use a high dose of thymoglobulin, and he suggested that, in light of these results, they may use a lower dose in the future.

[Presentation title: Low Dose Thymoglobulin Versus Simulect Induction in Adult Kidney Transplant With CNI Triple Immunosuppression: Efficacy and Safety. Abstract 980]

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