Comparison of clinical outcome of low-dose and high-dose rabbit antithymocyte globulin induction therapy in renal transplantation: a single-center experience

Abstract

Background: To explore a better balance between efficacy and complications, we respectively compared the clinical outcome of low-dose and high-dose rATG induction therapy with a control group in renal transplantations from March 2009 to March 2012.

Material and methods: 281 kidney transplant recipients were included in 3 groups. The low-dose group (n=39) received rATG 1 mg/kg on the first day and 0.5 mg/kg on the next consecutive 3 days post-transplantation. The high-dose group (n=30) received rATG 1 mg/kg for 6 days. The control group (n=212) received no induction therapy. All patients were treated with Prednisolone, Mycophenolate mofetil, cyclosporine A, or tacrolimus capsules. Acute rejection rates, renal function, CMV infection, patient survival, and the adverse effects of rATG were reviewed.

Results: The acute rejection rate was significantly lower in the rATG group compared with the control group (low-dose 17.9% vs. control 35.4%, P=0.03, and high-dose 16.7% vs. control 35.4%, P=0.038). There was no statistically significant difference in 3-year survival and graft survival rates among the groups. Renal function early recovery was similar in the rATG and the control group. The CMV infection rate in the high-dose rATG group was higher than the low-dose rATG and the control group (p=0.037 and p=0.002, respectively). rATG induction therapy was associated with thrombocytopenia in our series, especially in the high-dose rATG group.

Conclusions: Low-dose rATG induction may be superior to high-dose rATG induction therapy in renal transplantation.