Comparison of Long-Term Effect of Thymoglobulin Treatment in Patients With a High Risk of Delayed Graft Function

Abstract Background T-lymphocyte depletion is a strategy to reverse the impact of ischemia-reperfusion injury (IRI) in progression to chronic allograft dysfunction, especially among patients at high risk for delayed graft function (DGF). Methods The present work assessed the effect of thymoglobulin...

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Bibliographic Details
Published in:Transplantation proceedings 2012-10, Vol.44 (8), p.2428-2433
Main Authors: Requião-Moura, L.R, Ferraz, E, Matos, A.C.C, Tonato, E.J, Ozaki, K.S, Durão, M.S, Câmara, N.O.S, Pacheco-Silva, A
Format: Article
Language:English
Subjects:
Adult
Antilymphocyte Serum - administration & dosage
Antilymphocyte Serum - adverse effects
Biological and medical sciences
Brazil - epidemiology
Case-Control Studies
Chi-Square Distribution
Cold Ischemia - adverse effects
Cytomegalovirus Infections - epidemiology
Delayed Graft Function - diagnosis
Delayed Graft Function - epidemiology
Delayed Graft Function - prevention & control
Drug Administration Schedule
Female
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Graft Rejection - epidemiology
Graft Rejection - prevention & control
Graft Survival - drug effects
Humans
Immunosuppressive Agents - administration & dosage
Immunosuppressive Agents - adverse effects
Incidence
Kidney Function Tests
Kidney Transplantation - adverse effects
Kidney Transplantation - immunology
Logistic Models
Male
Medical sciences
Middle Aged
Multivariate Analysis
Risk Assessment
Risk Factors
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Time Factors
Tissue, organ and graft immunology
Treatment Outcome
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Summary:Abstract Background T-lymphocyte depletion is a strategy to reverse the impact of ischemia-reperfusion injury (IRI) in progression to chronic allograft dysfunction, especially among patients at high risk for delayed graft function (DGF). Methods The present work assessed the effect of thymoglobulin among a population with a high incidence of DGF. We analyzed 209 transplanted patients: 97 in the thymoglobulin and 112 in the control group. Results The main complication was DGF (59.3%), with a similar incidence in both groups (63.9% vs 55.3%; P = .36). Acute rejection episodes (ARE) were decreased with thymoglobulin (8.2% vs 28.5%; P < .001), but cytomegalovirus viremia was 3.4-fold more frequent (58.3% vs 17.1%; P < .001). One-year graft function was significantly better in the thymoglobulin group (59.2 ± 17.2 vs 51.8 ± 15.3 mL/min; P = .004), even when censored by ARE (59.7 ± 17.5 vs 53.3 ± 14.4; P = .023). The same difference was observed at the 2-year follow-up ( P = .024), even when censored for ARE ( P = .045). A multivariate analysis showed thymoglobulin to be a factor strongly associated with protection of graft function ( P = .039). Conclusion Despite not reducing the incidence of DGF, thymoglobulin induction significantly reduced the incidence of ARE and showed a long-term profile of protection of renal graft function, independent of the reduction in ARE.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2012.07.013