Comparison of efficacy and safety between rabbit anti-thymocyte globulin and anti-T lymphocyte globulin in kidney only transplantation: A retrospective observational study

Abstract

Introduction: The two formulations of antihuman thymocyte immunoglobulin that are used as T-cell depleting induction agents in renal transplantation are anti-thymocyte globulins (ATG) thymoglobulin and (antiT-lymphocyte globulin [ATLG]-Grafalon-formerly ATG-Fresenius). Very few trials have compared these two formulations. In this retrospective study, we compared the incidence of infections, rejections, graft survival, mortality, and lymphocyte profile of ATG and ATLG. Materials and Methods: This was a single-center retrospective study of 127 consecutive kidney-alone transplant recipients from January 2014 to June 2019. Patients received 3 mg/kg of ATG or 4 mg/kg single dose of ATLG. CD 3 counts were done on day 3 of the transplant. Most of the recipients received standard triple immunosuppression of tacrolimus, mycophenolate mofetil, and prednisolone. Results: Fifty-eight patients received ATG and 69 patients received ATLG. Baseline demographics were similar between the two groups. Death-censored graft survival (99%) (P = 0.258) and biopsy-proven acute rejection (BPAR) (32% vs. 29%, P = 0.128) were similar in both groups. Graft survival was better in ATLG group (92.7% vs. 87.5% P = 0.020). Bacterial infections (41.1% vs. 27.6%, P = 0.03) and sepsis-related mortality (11.54% vs. 4.34% P = 0.02) were significantly higher in the ATG group. Conclusion: ATLG, when used as an induction agent, was associated with a lesser rate of bacterial infections and sepsis-related mortality, but better graft survival as compared to ATG but has comparable BPAR, death-censored graft survival, and viral/fungal infections.