ANTI-THYMOCYTE RABBIT IMMUNOGLOBULIN: POSTOPERATIVE RISK FACTOR FOR SIROLIMUS TREATED RENAL TRANSPLANT PATIENTS

Abstract

O211 Aims: Improved efficacy of immunosuppression has decreased the length of post renal transplant hospitalization and has facilitated patient return to work. Randomized controlled studies of sirolimus treated renal transplant patients suggested an increased incidence in perioperative wound complications. This study analyzes the effect of Rabbit Anti-Thymocyte Globulin (RATG) on postoperative complications of sirolimus regimens. Methods: 412 renal transplants were performed and managed postoperatively at two university affiliated hospitals between January 1st 2001 and December 31st 2003 receiving corticosteroids and sirolimus, with delay of cyclosporine introduction until serum creatinine levels decreased below 3mg/dL. Patients were induced with Basiliximab 20mg on day 0 and day 4 (n=283) unless they had a high PRA or were retransplant patients; these latter groups received RATG for induction (n=129) until cyclosporine could be started, for a maximum of two weeks postoperatively. Postoperative hernia, wound infections and lymphoceles required drainage were noted for each group, and statistical significance of the differences in occurrence were analyzed by Chi-Square analysis. The incidence of rejection was 14.5% for Basiliximab vs. 8.5% for RATG induced patients. Only non-rejecting patients were included in the statistical analysis, to avoid confounding variable of rejection treatment. Patients with follow-up less than 30 days were also excluded. The study group included 350 patients, 235 with Basiliximab induction (group 1) and 115 with RATG induction (group 2). The mean follow-up was 21.8 months (SD ± 11). Results: The percentage of patients with wound complications was 26.0% vs. 39.1% (p 0.025) for group 1 and group 2 respectively. Incisional hernias occurred in 10.6% vs. 18.3% patients (p 0.05), patients with wound infections were 11.1% vs. 16.5% (p 0.2), while lymphoceles requiring drainage were 10.6% vs. 15.9% (p 1) for both groups respectively. Conclusions: RATG induced renal transplants managed with sirolimus, cyclosporine and steroids have a significant increase in postoperative wound complications. The incidence of incisional hernias was higher in thymoglobulin-induced patients with statistically significant difference. Lymphocele and wound infection complications were also higher but not statistically significant. Avoidance of RATG minimizes postoperative complications in sirolimus treated renal transplant patients.