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Effect of Induction Therapy Protocols on Transplant Outcomes in Crossmatch Positive Renal Allograft Recipients Desensitized with IVIG
Author(s) -
Vo A. A.,
Toyoda M.,
Peng A.,
Bunnapradist S.,
Lukovsky M.,
Jordan S. C.
Publication year - 2006
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2006.01472.x
Subject(s) - thymoglobulin , medicine , incidence (geometry) , antibody , renal function , induction therapy , kidney transplantation , gastroenterology , urology , cumulative incidence , urinary system , renal transplant , kidney , transplantation , chemotherapy , immunology , physics , optics
Here we retrospectively examine the efficacy of two antibody induction regimens using Zenapax ® or Thymoglobulin ® in patients with positive complement‐dependent cytotoxicity crossmatches (CDC‐CMXs) desensitized with IVIG (intravenous immunoglobulin). Between January 1999 and March 2005, 97 patients with (+) CDC‐CMXs received kidney transplants (43 deceased donors/54 living donors). All patients received at least 2 g/kg IVIG (maximum four doses) until an acceptable CMX was obtained. Patients were divided into two groups: 1. IVIG + Zenapax ® (n = 58), 2. IVIG + Thymoglobulin ® (n = 39). A total of 94% of patients in Group 1 and 84% in G2 have at least 2 years of follow up. Patient and graft survival was 96%/84% in Group 1 and 100%/90% in Group 2, p = NS. The number and severity of AR episodes were similar (36% Group 1 vs. 31% Group 2, p = NS) as was the incidence of C4d (+) antibody‐mediated rejection (AMR) (Banff Grade II/III) (22% Group 1 vs. 21% Group 2). Mean serum creatinines (SCrs) at 24 months were similar (Group 1: 1.4 ± 0.7 vs. G2: 1.5 ± 0.7 mg/dL). Induction therapy with Zenapax ® or Thymoglobulin ® results in excellent patient, graft survival and graft function at 2 years. There was no increased risk of viral infections or malignancies with either agent. Neither agent was effective in reducing the incidence of AMR.