316.5: Long Term Outcomes of Low Dose Anti-thymocyte Globulin And Anti-interleukin-2 Receptor Antibody Induction in Kidney Transplantation From Expanded Criteria Donors

Abstract

Background: Using kidneys from expanded criteria donors (ECD) has been increased due to the shortage of donor organs but seemed to have poorer prognosis. The aim of this study was to evaluate the safety and efficacy of rabbit anti-thymocyte globulin (rATG) induction in kidney transplantation (KT) from ECD compared to anti IL-2 receptor antibody (basiliximab). Methods: We retrospectively analyzed 182 patients who underwent KT from ECDs between April 2004 and December 2020. The patients were categorized into two groups according to induction therapy modality. The basiliximab group (n=43) received basiliximab 20mg/kg on day 0 and 4, while low dose rATG group (n=139) received rATG 1.5mg/kg on day 0, 1, and 2. Both groups received tacrolimus, mycopheonolate, and steroids as maintenance immunosuppressive agents. Results: The mean donor age (60.6 vs 64.3, p = 0.007) and KDPI score (84.4 vs 90.0, p = 0.005) were higher in rATG group. Patients in rATG group showed more delayed graft function (11.6% vs 30.9%, p = 0.021) but no significant difference in biopsy proven acute rejection (41.9% vs 35.3%, p =0.546). However, graft survival rates (p = 0.88) and overall survival rates (p = 0.846) were not significantly different between the two groups. CMV infection rate seemed higher in rATG group, but graft survival rate was not influenced by CMV infection (p =0.677). Conclusion: Low dose rATG induction in KT from ECD resulted in comparable patient and graft survival despite the worse donor and recipient profile comparing to basiliximab induction. Therefore, low dose rATG can be considered as an effective and safe induction therapy in KT from ECD.