ANALYSIS OF REJECTION AND ATN AFTER INDUCTION WITH ATG, BASILIXIMAB AND DACLIZIMAB IN CADAVERIC KIDNEY TRANSPLANT RECIPIENTS

Abstract

14 Basiliximab (Simulect) and daclizumab (Zenapax) are monoclonal antibody therapies directed against the alpha subunit of the IL-2 receptor. Although basiliximab and daclizumab have similar mechanisms of action, daclizumab requires 5 doses compared to 2 doses of basiliximab. The cost per dose of basiliximab and daclizumab are comparable ($1224 and $1254 respectively). We examined the recent use of basiliximab and daclizumab in our center and compared the results to ATG (ATGAM) induction in cadaveric renal allografts. 106 patients were treated with ATG from 1/92 to 3/98. 69 patients were induced with basiliximab from 12/97 to 12/98. 37 recipients were induced with daclizumab from 7/97 to 7/98. Maintenance immunosuppression consisting of prednisone, mycophenolate mofetil or azathioprine and cyclosporine or FK506 was used in all patients. Demographics such as recipient age, sex and race were comparable in each treatment group. Rejection and ATN rates are depicted below. (Table)TableExamination of early allograft rejection (1 - 2 months post-transplant) showed the highest rate of rejection among those patients treated with daclizumab while similar early rejection rates were seen in those patients treated with basiliximab and ATG. Late allograft rejection rates (3-4 months post-transplant) were not significantly different in patients treated with basiliximab and daclizumab (p=0.65) and higher than ATG recipients. Rates of post-transplant ATN (as defined by the need for hemodialysis post-transplant) were not statistically different between treatment groups. However, when rejection rates in recipients with post-transplant ATN were examined, recipients induced with ATG had less rejection than those treated with either basiliximab or daclizumab (p=0.06). Lack of a statistically significant difference in rejection with ATN could be attributed to the small number in each treatment group. The total cost of treatment with Zenapax ($6270) was greater than that of a course of Simulect ($2448). Given the similar rejection rates for Simulect and Zenapax at 120 days post-transplant, Simulect appears to be the more economic choice. While ATG is more expensive than both Simulect and Zenapax, patients with post-transplant ATN induced with ATG had a lower incidence of rejection.