Acute Rejection Risk in Kidney Transplant Recipients on Steroid-Avoidance Immunosuppression Receiving Induction With Either Antithymocyte Globulin or Basiliximab

Immunosuppression with rapid discontinuation of corticosteroids, usually with induction therapy, is safe in kidney transplant recipients. In 89 patients, we induced immunosuppression with basiliximab or rabbit antithymocyte globulin (17 and 72 patients, respectively). Selection criteria for basilixi...

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Bibliographic Details
Published in:Transplantation proceedings 2006-06, Vol.38 (5), p.1307-1313
Main Authors: Heilman, R.L., Reddy, K.S., Mazur, M.J., Moss, A.A., Post, D.J., Petrides, S., Mulligan, D.C.
Format: Article
Language:English
Subjects:
Acute Disease
Adrenal Cortex Hormones
Adult
Aged
Animals
Antibodies, Monoclonal - adverse effects
Antilymphocyte Serum - adverse effects
Female
Graft Rejection - epidemiology
Humans
Immunosuppressive Agents - adverse effects
Kidney Transplantation - immunology
Male
Middle Aged
Patient Selection
Rabbits
Recombinant Fusion Proteins - adverse effects
Risk Factors
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Summary:Immunosuppression with rapid discontinuation of corticosteroids, usually with induction therapy, is safe in kidney transplant recipients. In 89 patients, we induced immunosuppression with basiliximab or rabbit antithymocyte globulin (17 and 72 patients, respectively). Selection criteria for basiliximab were age (≥65 years), history (malignancy; chronic infection), and type 1 diabetes mellitus (eligible for pancreas transplant). Steroids were administered through posttransplantation day 4 (five doses); maintenance immunosuppression was with tacrolimus and mycophenolate mofetil. At last follow-up (average, 286 days), most patients were steroid-free (antithymocyte globulin, 90%; basiliximab, 88%). Protocol biopsies were performed at 1, 4, and 12 months posttransplantation. The overall risk of biopsy-proven acute rejection was 12%. At 6 months posttransplantation, acute rejection-free survival was 93% for antithymocyte globulin, 65% for basiliximab ( P < .001). Median time to biopsy-proven acute rejection was 27 and 71 days, respectively. The low incidence of biopsy-proven acute rejection with steroid-avoidance immunosuppression may be further reduced with antithymocyte globulin.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2006.02.116