Background: Antithymocyte globulin (ATG) is widely used as an induction therapy after kidney transplantation. The present study aimed to compare the effectiveness and safety of induction therapy between two ATG formulations, Grafalon (Fresenius® ) and Thymoglobulin (Sanofi® ), in kidney transplant patients.
Methods: This study included 140 consecutive kidney transplant recipients, 71 treated with Grafalon and 69 treated with Thymoglobulin, in the period between February 2010 and January 2018. To optimize therapy costs, considering the periodically limited drug availability and the substantial drug waste in the case of Grafalon, Thymoglobulin induction was introduced into the immunosuppressive protocol.
Results: The ATG total dose in mg/kg of body mass [median: 5.3 (3.7-7.1) vs 8.6 (4.3-17.3); P < .001] was significantly lower in the Thymoglobulin subgroup. There were 7 (5%) graft losses and 15 (10.7%) deaths during the first 12 months, with 66.7% of deaths due to infection complications. Patients treated with Thymoglobulin were characterized by a lower absolute lymphocyte count at day 7 and during the 12 months of follow-up, compared with the Grafalon group [236 (205-267) vs 483 (372-594), respectively; P < .001]. Logistic regression analysis showed that a lymphocyte count < 200/µL at day 7 (OR = 10.5; 95%CI, 1.6-69.0; P = .01) and age >50 years (OR = 14.6; 95%CI, 1.4-155.0; P = .03), but not type of ATG, independently increased the risk of death due to infection. The 12-month acute rejection rate was higher in the Grafalon group (25.3% vs 10.1%, P = .02).
Conclusion: Treatment with Thymoglobulin in kidney transplant recipients resulted in more pronounced lymphopenia and a lower 12-month rate of acute rejection.
Keywords: antithymocyte globulin; complications; induction; kidney transplant; mortality.
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.