The appropriate dose of thymoglobulin induction therapy inkidney transplantation.

Abstract

Thymoglobulin is used effectively as an induction agent in kidney transplantation, but there is no consensus on the optimal dose. In order to delineate the safest effective dose, an open-labeled randomized clinical trial was designed. In this study, 90 adult kidney transplant recipients (KTR) were randomized before transplantation in three groups to receive thymoglobulin: Arm A (4.5mg/kg in 3days), Arm B (4.5mg/kg single bolus dose), and Arm C (6mg/kg in 3days). Renal function, infections, and rate of readmissions were evaluated during the first post transplantation year. Ninety adult kidney recipients were enrolled (51% deceased donor). No significant statistical difference was found in acute rejection episodes or type of rejection between these groups, although patients in Arm A showed more severe histopathologic changes according to Banff 2013 criteria, in renal biopsies (P=.03). At the first month after transplantation serum Cr was lower (P=.001) and GFR was higher (P=.04) in Arm A, but there was no significant difference among the three groups at 3, 6, and 12 months post-transplant. Although all regimens showed the same efficacy regarding the rate of rejection episodes, 3-day 4.5mg/kg Thymoglobulin had significantly fewer complications.