Korean J Transplant.  2019 Dec;33(4):118-127. 10.4285/jkstn.2019.33.4.118.

Comparison of clinical outcomes of deceased donor kidney transplantations, with a focus on three induction therapies

• Jeong ES
• Lee KW
• Kim SJ
• Yoo HJ
• Kim KA
• Park JB

• KMID: 2468162
• DOI: http://doi.org/10.4285/jkstn.2019.33.4.118

Abstract

BACKGROUND
Graft survival rate of kidney transplantation recipients improves after induction therapy. However, there is no conclusive evidence on which regimen is superior for deceased donor kidney transplantation (DDKT). This study aims at discussing effective induction therapy in DDKT.
METHODS
Between 2003 and 2016, 395 DDKT recipients were divided into three groups following induction therapy. Recipients of the basiliximab group (n=184) received basiliximab (20 mg/kg) on days 0 and 4. Recipients of the low-dose rabbit anti-thymocyte globulin (rATG) group (n=113) received rATG (1.5 mg/kg) on days 0, 1, and 2, while those of the high-dose rATG group (n=98) received it for more than 4 days. We retrospectively reviewed and analyzed the clinical outcomes and adverse effects of induction therapy.
RESULTS
Compared to other groups, the low-dose rATG group donors were older (P<0.001); rATG group donors had higher serum creatinine levels (P<0.001), and the basiliximab group showed a lower delayed graft function rate (P=0.004). In graft failure, the low-dose rATG group did not differ significantly from the basiliximab group (P=0.080), but was significantly different from the high-dose rATG group (P=0.004).
CONCLUSIONS
The low-dose rATG group had the best graft survival rate, although it had older donors and higher serum creatinine levels. Therefore, low-dose rATG may be considered an effective induction therapy in DDKT.

Keyword

Kidney transplantation; Immunosuppressive agent; Graft rejection

MeSH Terms

Antilymphocyte Serum
Creatinine
Delayed Graft Function
Graft Rejection
Graft Survival
Humans
Kidney Transplantation*
Kidney*
Retrospective Studies
Tissue Donors*
Transplants
Antilymphocyte Serum
Creatinine

Figure

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  Fig. 1 Graft survival and recipient survival curves. Comparison of graft survival (A) and recipient survival (B) post kidney transplantation between the three groups. ATG, anti-thymocyte globulin.

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  Fig. 2 Graft function post kidney transplantation. Comparison of the post-transplantation serum Cr levels (A) and eGFR (B) of the three groups. Cr, creatinine; eGFR, estimated glomerulus filtration rate; ATG, anti-thymocyte globulin.

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  Fig. 3 Graft survival according to cytomegalovirus (CMV) infection (CMV ≥50/400,000). (A) CMV infection positive group vs. CMV infection negative group. (B) CMV infection positive group vs. CMV infection negative group within 1 year of kidney transplantation.

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