The Influence of Single Dose Induction Therapy on Graft Function in a Developing Country

Abstract

Introduction: Induction with single dose therapy is rarely practiced in renal transplantation. Hence, we did this prospective study to see the influence of single dose induction therapy on graft function. Methods: Our study cohort comprised 358 patients (253 Males, 105 females) with a mean age of 43.42±13.22. Patients were divided into 4 groups based on the choice of induction therapy used (Basiliximab, Daclizumab, Thymoglobulin or no induction). Details such as age, sex, modality of dialysis and related details prior to transplantation, induction and immunosuppressive regimen, rate of rejection, diabetic status, previous transfusions, previous pregnancies, biopsy results and mortality were collected. Analysis was done using PASW Statistics 18 with chisquare test and one way Anova with post-hoc Tukey. The PRA values in thymoglobin was 26.17% ± 8.63% (Range:12.5% to 45.5%). The cost of the drugs is as follows - Basiliximab USD 1122, Thymoglobulin USD 551 and Daclizumab USD 800. Results: Of the 358 patients, single dose-induction was initiated on 310 patients; 125 with Basiliximab, 143 with Daclizumab (2 doses) and 42 patients with Thymoglobulin. Overall, 29.9% of patients were diabetic, however this was not significantly different across the groups (p=0.25). The transfusion rate was 53.8% in patients on thymoglobulin induction while the overall rate of transfusion was only 21.1% (p < 0.001). A positive biopsy report was seen in 24.5% of all patients (20.8% no induction; 27.2% Basiliximab, 23.8% Daclizumab, 23.1% Thymoglobulin) (p=0.82). Death-censored graft survival showed a lower incidence of graft survival with no induction (87.1%) (p=0.54).[Table 1 - Demographic and renal parameters]Figure: [Death-censored graft survival]Conclusion: Our study shows that single dose induction with thymoglobulin is the most cost effective modality in preventing rejection in patients with high PRA.