Which Induction Therapy Should Be Used in Kidney Transplants with Prolonged Cold Ischemia Time?

Abstract

With the aim to retrospectively analyze the impact of different induction therapies on transplant results of non-sensitized, first, isolated, adult, deceased kidney transplants who were submitted to cold ischemia times (CIT) ≥ 24 hours, 51 patients treated with Basiliximab (GI) were compared to 81 patients treated with Thymoglobulin (GII). Transplants were performed between Jan/2007 and July/2011. Maintenance longterm immunosuppression consisted of Tacrolimus, Mycophenolate and Prednisone in both groups. Patients treated with Thymoglobulin received CMV prophylaxis for 3 months with Gancyclovir. Demographic data are summarized in Table I. No differences were detected on recipient age and gender and brain death cause. Time on dialysis pre transplantation, donor age, donor Scr and CIT time were higher in GII. Follow-up time was longer in GI. Results were not different, except for CMV disease and are shown on Table II. Figure 1 shows the evolution of Scr over the 1st year in both groups. Demographic data GI (N= 51 ) GII (N= 81 ) p Recipient gender (M/F) 31/20 51/30 NS Recipient age (y) 49.9 49.6 NS Stroke as brain death cause (%) 64 62 NS Time on dialysis pre Tx (m) 85 184 0.02* Donor age (y) 47 53 0.02* CIT (hours) 26 28 0.01* Donor Scr (mg/dl) 1.4 1.8 0.02* * p< 0.05 Results GI (N= 51 ) GII (N= 81 ) p DGF rate (%) 67 63 NS Number of days at 1st hospitalization 19 18 NS Hospital readmission rate 0.7 (1.5/pt) 0.7 (1.4/pt) NS cute rejection rate (% ) 19 11 NS Acute rejection rate (% ) CMV rate (%) 27 13 0.04* 1y patient Survival 83 83 NS 1y graft Survival 81 79 NS * p< 0.05 In our center, patients who received kidneys with long ischemia time presented extremely high DGF rates and an impact on renal function at one year was observed. In this cohort, recipients treated with Thymoglobulin received more frequently kidneys from marginal donors with longer CIT, but the use of Thymoglobulin provided similar one year patient and graft survival and a tendency to lower acute rejection rates in these patients.