Perioperative Minimal Induction Therapy : A Further Step toward More Effective Immunosuppression in Transplantation

Abstract EN

Dual induction with low doses of rabbit anti-human thymoglobulin (RATG) and basiliximab effectively and safely prevented allograft rejection in high-risk renal transplant recipients.

To assess whether treatment timing affects efficacy and tolerability, in this single-center, matched-cohort study, we compared posttransplant outcomes in 25 patients and 50 gender-, age-, and treatment-matched reference patients induced with the same course of 7 daily RATG infusions (0.5 mg/kg/day) started before or after engraftment, respectively.

All subjects received basiliximab (20 mg) before and 4 days after transplantation, withdrew steroids within 6 days after surgery, and were maintained on steroid-free immunosuppression with cyclosporine and mycophenolate mofetil or azathioprine.

Over 12 months after transplant, 1 patient (4%) and 13 reference patients (26%) had acute rejection episodes.

One patient and 5 reference-patients required dialysis therapy because of delayed graft function.

In all patients circulating CD4+ and CD8+ T lymphocytes were fully depleted before engraftment.

Both treatments were well tolerated.

In kidney transplantation, perioperative RATG infusion enhances the protective effect of low-dose RATG and basiliximab induction against graft rejection and delayed function, possibly because of more effective inhibition of early interactions between circulating T cells and graft antigens.