Assessment of infectious complications in elderly kidney transplant recipients receiving induction with anti-thymocyte globulin vs basiliximab

Christine Pham, Samantha A Kuten, Richard Knight, Duc T Nguyen, Edward Graviss, A Osama Gaber

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background: Elderly transplant recipients experience lower rates of acute rejection with higher rates of infectious complications compared to their younger counterparts. While less intensive immunosuppression may be preferable, there are no recommendations for depleting versus non-depleting induction strategies. We sought to compare infectious complications between anti-thymocyte globulin (ATG) and basiliximab (IL2RA) induction in elderly kidney transplant recipients (KTRs). Methods: We reviewed 146 KTRs ≥65 years receiving ATG or IL2RA induction. Per institution protocol, ATG was administered to patients with the following characteristics, irrespective of age: African American (AA), PRA ≥20%, and/or re-transplantation. Infectious complications (bacterial, viral, and invasive fungal) at 1 year were compared. Results: There were significantly more AA, deceased donors, and sensitized KTRs in the ATG group, reflecting criteria for induction agent. ATG KTRs experienced higher rates of overall infectious complications (77% vs 56%, P =.01), driven by increased bacterial (54% vs 39%, P =.08) and viral infections (51% vs 35%, P =.05). Urinary tract infections (UTIs) and CMV in particular occurred at high rates among ATG patients (46% and 32%, respectively). In multivariate analysis, the only independent risk factor associated with increased risk for infection was induction with ATG (adjusted HR 1.71 [95% CI 1.04-2.83], P =.04). Overall rates of immunologic outcomes were low. Conclusion: Elderly KTRs receiving ATG are at an increased risk for infectious complications, largely attributed to high rates of UTIs and CMV. Additional strategies aimed at mitigating these complications in elderly patients requiring ATG may be beneficial.

Original languageEnglish (US)
Article numbere13257
Pages (from-to)e13257
JournalTransplant Infectious Disease
Issue number3
Early online dateFeb 7 2020
StatePublished - Jun 2020


  • elderly
  • induction
  • infection
  • kidney transplant
  • Graft Rejection/prevention & control
  • Communicable Diseases/etiology
  • Antilymphocyte Serum/adverse effects
  • Age Factors
  • Humans
  • Risk Factors
  • Male
  • Basiliximab/adverse effects
  • Transplant Recipients/statistics & numerical data
  • Kidney Transplantation/adverse effects
  • Immunosuppressive Agents/adverse effects
  • Female
  • Aged
  • Retrospective Studies

ASJC Scopus subject areas

  • Infectious Diseases
  • Transplantation


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