Rabbit antithymocyte induction and dosing in deceased donor renal transplant recipients over 60yr of age

Samir J. Patel, Richard J. Knight, Wadi N. Suki, Abdul Abdellatif, Benjamin T. Duhart, Amy G. Krauss, Saurabh Mannan, Nosratollah Nezakatgoo, A. Osama Gaber

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

Background: Antithymocyte globulin (rATG) is a commonly used induction agent in renal transplantation; however, data in older kidney recipients are limited. Methods: We reviewed charts of 301 deceased donor renal transplants who received a protocol consisting of 3-7 doses of rATG and triple maintenance therapy. Outcomes of patients >60yr of age (n=45) were compared to those aged 18-59yr (n=256). Results: Older recipients had more diabetics, were more likely to receive expanded criteria donor kidneys (p<0.01), and over 30% were sensitized. Recipients >60 received less cumulative rATG (4.6 vs. 5.1mg/kg; p<0.01). Three-yr acute rejection was lower in the >60 group (2% vs. 16%, p<0.01) although glomerular filtration rates were similar between groups. Actuarial graft survival was similar; however, patient survival in the >60 group at threeyr was lower (80% vs. 95%; p=0.02). Specifically, patients >60 with delayed graft function and rATG cumulative dosing >6mg/kg had a survival of <50% by twoyr. Conclusion: Recipients over 60yr receiving rATG induction have acceptable renal function and a low risk of rejection; however, reduced survival was noted among those receiving >6mg/kg. These data suggest that when used, lower cumulative dosages of rATG are preferable in the older recipient.

Original languageEnglish (US)
JournalClinical Transplantation
Volume25
Issue number3
DOIs
StatePublished - May 1 2011

Keywords

  • Antibody induction
  • Elderly
  • Kidney transplantation
  • Rabbit antithymocyte globulin

ASJC Scopus subject areas

  • Transplantation

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