Korean J Transplant.  2023 Nov;37(Suppl 1):S212. 10.4285/ATW2023.F-8023.

Comparison of the effectiveness and safety of rabbit anti-thymocyte globulin and basiliximab as induction agents in ABO-incompatible kidney transplants: a Korean Organ Transplantation Registry-based study

• Oh N
• Lee KW
• Park S
• Park JB
• Kang SH
• Ban TH
• Song SH
• Yang J
• Kim MS

• KMID: 2551832
• DOI: http://doi.org/10.4285/ATW2023.F-8023

Abstract

This study compares the safety and effectiveness of rabbit anti-thymocyte globulin (rATG) and basiliximab, two widely used induction agents, in ABO-incompatible kidney transplants (ABOi KT). Leveraging the extensive data from the Korean Organ Transplantation Registry, the outcomes of 818 patients receiving either rATG (n=152) or basiliximab (n=666) were evaluated. The baseline characteristics, including age, gender, body mass index, and baseline diseases, were comparable between the two groups, as were the characteristics of the donors. The immunological features revealed a higher proportion of patients with donor-specific antibodies and high panel reactive antibodies in the rATG group, though pretransplant maximum Immunoglobulin G (IgG) and IgM antibody titers showed no difference between the groups. Effectiveness was evaluated through death-censored graft survival (P=0.208) and rejection-free survival (P=0.296). Safety was assessed through patient overall survival (P=0.597), infection-free survival (P=0.294), and malignancy-free survival (P=0.634). No statistically significant differences were observed between the two groups in terms of either effectiveness or safety. The use of rATG was not associated with a significant hazard ratio (HR) for any of the outcomes when compared to the use of basiliximab. The HR for death (HR, 1.00; 95% confidence interval [CI], 0.21–4.85; P=0.996), graft failure (HR, 2.42; 95% CI, 0.54–10.87; P=0.25), rejection (HR, 1.39; 95% CI, 0.88–2.19; P=0.158), infection (HR, 0.81; 95% CI, 0.51–1.28; P=0.368), and malignancy (HR, 0.85, 95% CI, 0.09–7.59; P=0.882) were reported, indicating no significant positive or negative impact. In conclusion, our findings suggest that the use of rATG as induction therapy in ABOi KT is comparable to the use of basiliximab in terms of both effectiveness and safety.