Abstract: SA-PO506

Induction Therapy with Low Dose Thymoglobulin versus Standard Therapy with Basiliximab: A Comparative Study of Safety and Effectiveness in Marginal Donor Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Comai, Giorgia, University of Bologna, Bologna, Italy
  • Baraldi, Olga, University of Bologna, Bologna, Italy
  • Cuna, Vania, University of Bologna, Bologna, Italy
  • Ravaioli, Matteo, University of Bologna, Bologna, Italy
  • Cappuccilli, Maria, University of Bologna, Bologna, Italy
  • La Manna, Gaetano, University of Bologna, Bologna, Italy
Background

In renal transplant the most commonly administered induction immunosupprive therapy is based on Basiliximab, a chimeric non depleting anti-IL2-receptor monoclonal antibody, or Thymoglobulin, a polyclonal depleting agent.
The use of Thymoglobulin in the recipients of marginal kidney transplants is an attractive opportunity, since besides the known anti-rejection effect, it has a protective potential against ischemia/reperfusion injury and the subsequent delayed graft function (DGF), thus allowing the reduction of maintenance therapy.

Methods

We retrospectively analyzed 71 patients who received a kidney transplant from marginal donors in the period 2013-2015 to assess the safety (incidence of infections, new onset diabetes after transplantation-NODAT, cardiovascular events) and efficacy (rejection rate, graft survival, DGF, graft function) of two different induction regimens during the 2-year follow-up period: Basiliximab (n=39) vs Thymoglobuline (n=32) at a very low dose (with a cumulative dose of 2 mg/kg).

Results

The two groups were similar for donor and recipient age, but there were different frequencies of double renal transplants: 4/39 (10.3%) in Basiliximab group and 18/32 (56.2%) in Thymoglobulin group (p<0.01). Likewise, ischemia interval and Karpinski score were higher in the Thymoglobulin group (p<0.05).
The safety of the two induction regimens was comparable, as no significant differences were found in the incidence of infections, NODAT and cardiovascular events. Concerning the parameters used to evaluate efficacy, rejection rate, graft survival and DGF did not differ significantly between the groups, while serum creatinine (sCreat) and proteinuria were higher in Basiliximab group that in Thymoglobulin group (sCreat: 1.8 ± 0.3 vs 1.6 ± 0.4 mg/dL; p=0.019; urine protein levels: 37 ± 21 vs 17 ± 18 mg /dL; p<0.01).

Conclusion

Induction therapy with low dose thymoglobulin has been shown to have a comparable efficacy with Basiliximab, also showing an excellent safety profile. This finding appears to be promising, also in view of unfavourable characteristics of the transplanted patients included in the Thymoglobulin group, namely double kidney transplant, longer cold ischemia time and higher Karpinski score.