Renal Allograft Outcome and Infectious Complications Following Antithymocyteglobulin and Alemtuzumab Used as Induction in Kidney Transplantation.

Abstract

Background: Antithymocyte globulin (ATG) and Humanized Monoclonal Anti-CD52 Antibody, Alemtuzumab (Targeted all T-cells depleting antibodies) were used as induction regimens for kidney transplantation. However, both drugs have been questionable in threatened Infectious complications which would be the main barriers to patients and allograft disease-free survival. Methods: Sixty-eight patients (Cadeveric donor 38, Living donor 30) who have been performed transplantation between July 1996 - 2009 were retrospective study analyzed kidney allograft outcome and infectious complications after induction therapy between ATG 200-400 mg, ATG 500-700 mg 1 given intravenously and alemtuzumab 30 mg given subcutaneously. Immunosuppressive agents were Tacrolimus(88.2%), Cyclosporin A(8.8%), Mycophenolate mofetil(52.9%), Azathioprine(35.2%), Everolimus(0.3%) and corticosteroids. Standard perioperative antimicrobial prophylaxis consisted of ceftriaxone in combination with Fluconazole, Trimethoprim-sulfamethoxazole and Acyclovir in high risk patients. Results: Patient and kidney graft survival at thirteen years was 95.58%. The rejection rate in low dose ATG group was 20.58%, high dose ATG was 32.14 (p-value = ns). There was no incidence of rejection in alemltuzumab group. Three grafts from ATG group were lost from rejection. The mild grade infection rate 65 events/302 patient years, moderate grade 51 event/302 patient years, severe infection 8 event/302 pateient years with no difference in terms of prevalence according to the three groups. Conclusion: ATG and alemtuzumb are effective for use as induction regimens. Infectious complications are comparable between low dose ATG, high ATG and alemtuzumab.