Author(s): Bchler M, Hurault de Ligny B, Madec C, Lebranchu Y French Thym
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Abstract BACKGROUND: Two hundred and forty cadaveric renal transplant recipients given anti-thymocyte globulin (Thymoglobulin) as induction immunotherapy were followed up prospectively to review safety and efficacy. METHODS: The median number of infusions was 10 [2-21] with a cumulative dose of 8.8 mg/kg [2.0-23.2 mg/kg]. During the fortnight following transplantation, 231 patients (96\%) received a calcineurin inhibitor; all patients were given steroids and azathioprine or mycophenolate mofetil. At 1 yr, 60\% of patients were on tripletherapy, 38\% on bitherapy, and 2\% on monotherapy; 20\% had discontinued steroids. RESULTS: Tolerance was excellent with no cases of anaphylaxis. The commonest adverse event was fever (55\%). Eighteen patients developed serum sickness on median day 11 [10-14]. Seven patients had thrombocytopenia; six patients had severe neutropenia. All of these adverse events recovered spontaneously. The overall incidence of delayed graft function was 24\%. At 1 yr patient and graft survival were 98 and 95\%, respectively, and creatinine was 135 +/- 43 micromol/L. Clinically suspected and biopsy-proven acute rejection were observed in 65 patients (27\%) and 34 patients (14\%), respectively. There were 62 non-cytomegalovirus (CMV) infections (two fatal) and 81 episodes of CMV infections. Eight malignancies were reported; two possibly related to immunosuppression. CONCLUSIONS: These results demonstrate that anti-thymocyte globulin has a safety profile with good tolerability and excellent efficacy.
This article was published in Clin Transplant
and referenced in Journal of Metabolic Syndrome