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Previous Volume 355:1967-1977 November 9, 2006 Number 19 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Editorial by Josephson, M. A. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Induction therapy reduces the frequency of acute rejection and delayed graft function after transplantation. A rabbit antithymocyte polyclonal antibody or basiliximab, an interleukin-2 receptor monoclonal antibody, is most commonly used for induction.

Methods In this prospective, randomized, international study, we compared short courses of antithymocyte globulin and basiliximab in patients at high risk for acute rejection or delayed graft function who received a renal transplant from a deceased donor. Patients taking cyclosporine, mycophenolate mofetil, and prednisone were randomly assigned to receive either rabbit antithymocyte globulin (1.5 mg per kilogram of body weight daily, 141 patients) during transplantation (day 0) and on days 1 through 4 or basiliximab (20 mg, 137 patients) on days 0 and 4. The primary end point was a composite of acute rejection, delayed graft function, graft loss, and death.

Results At 12 months, the incidence of the composite end point was similar in the two groups (P=0.34). The antithymocyte globulin group, as compared with the basiliximab group, had lower incidences of acute rejection (15.6% vs. 25.5%, P=0.02) and of acute rejection that required treatment with antibody (1.4% vs. 8.0%, P=0.005). The antithymocyte globulin group and the basiliximab group had similar incidences of graft loss (9.2% and 10.2%, respectively), delayed graft function (40.4% and 44.5%), and death (4.3% and 4.4%). Though the incidences of all adverse events, serious adverse events, and cancers were also similar between the two groups, patients receiving antithymocyte globulin had a greater incidence of infection (85.8% vs. 75.2%, P=0.03) but a lower incidence of cytomegalovirus disease (7.8% vs. 17.5%, P=0.02).

Conclusions Among patients at high risk for acute rejection or delayed graft function who received a renal transplant from a deceased donor, induction therapy consisting of a 5-day course of antithymocyte globulin, as compared with basiliximab, reduced the incidence and severity of acute rejection but not the incidence of delayed graft function. Patient and graft survival were similar in the two groups. (ClinicalTrials.gov number, NCT00235300 [ClinicalTrials.gov] .)

Source Information

From the Renal Division, Washington University School of Medicine, Barnes–Jewish Hospital, St. Louis (D.C.B.); the University of Texas Medical Branch, Galveston (J.A.D.); the Departments of Internal Medicine and Surgery, University of Michigan, Ann Arbor (K.D.L., D.C.); and the Hospital Reina Sofia, Cordoba, Spain (D.D.C.).

Address reprint requests to Dr. Brennan at Washington University School of Medicine, Renal Division, Campus Box 8126, St. Louis, MO 63110, or at dbrennan{at}wustl.edu.

Full Text of this Article

Related Letters:

Antithymocyte Globulin versus Basiliximab in Renal Transplantation
Killen J. P., Chadban S., Brennan D. C., Buchanan P., Schnitzler M. A.
Extract | Full Text | PDF  
N Engl J Med 2007; 356:634-635, Feb 8, 2007. Correspondence

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