Background/Aims: In renal transplantation, peri-operative low-dose rabbit-antithymocyte-globulin (RATG) plus basiliximab induction prevented acute allograft rejection more effectively than post-operative RATG plus basiliximab induction. We investigated the specific antirejection contribution of basiliximab in this context. Methods: This single-center, observational, matched-cohort study evaluated allograft rejections (primary outcome), steroid exposure and side effects, GFR (iohexol plasma clearance) and treatment costs in 16 deceased-donor renal transplant recipients induced with RATG (0.5 mg/kg/day) and 32 age-, gender- and treatment-matched reference-patients given RATG plus basiliximab (20 mg on days 0 and 4). Results: Induction was well tolerated. At 18 months, 8 patients (50%) vs. 3 reference-patients (9.4%) rejected the graft [HR (95% CI): 6.53 (1.73-24.70), p = 0.006]. Difference was significant (p < 0.01) even after adjusting for recipient/donor age and gender, cold ischemia time and HLA mismatches. There were 1 antibody-mediated rejection and 2 moderate cellular rejections in patients vs. none in reference-patients (p = 0.032). The median (interquartile range) prednisone cumulative dose was remarkably higher in patients than reference-patients [4.78 (1.12-6.10) vs. 0.19 (0.18-3.81) grams, p = 0.002]. Three patients vs. 24 reference-patients were off-steroid at study end (p < 0.001). Three patients vs. no reference-patient developed new-onset diabetes (p = 0.003). Both inductions similarly depleted B-cells. Outcomes of AZA- vs. MMF-treated participants were similar. GFR was similar in all groups. Compared to MMF, AZA therapy saved ≈ EUR 2,500/year and by month 14.3 post-transplant compensated basiliximab costs. Conclusion: In renal transplantation, basiliximab plus peri-operative low-dose RATG more efficiently prevented allograft rejection than RATG monotherapy, and minimized steroid exposure and toxicity. AZA- vs MMF-based maintenance immunosuppression largely compensated the extra costs of basiliximab.
Low-dose RATG with or without basiliximab in renal transplantation : a matched-cohort observational study / G. Gentile, C. Somma, A. Gennarini, D. Mastroluca, G. Rota, F. Lacanna, B. Locatelli, G. Remuzzi, P. Ruggenenti. - In: AMERICAN JOURNAL OF NEPHROLOGY. - ISSN 0250-8095. - 41:1(2015 Feb), pp. 16-27.
|Titolo:||Low-dose RATG with or without basiliximab in renal transplantation : a matched-cohort observational study|
REMUZZI, GIUSEPPE (Penultimo)
|Parole Chiave:||Basiliximab; Graft rejection; Induction; Kidney transplantation; Minimization; Steroid withdrawal; Thymoglobulin; Adult; Aged; Animals; Anti-Inflammatory Agents; Antibodies, Monoclonal; Antilymphocyte Serum; Azathioprine; CD4 Lymphocyte Count; Cohort Studies; Diabetes Mellitus; Drug Therapy, Combination; Female; Glomerular Filtration Rate; Graft Rejection; Humans; Immunosuppression; Immunosuppressive Agents; Induction Chemotherapy; Maintenance Chemotherapy; Male; Middle Aged; Mycophenolic Acid; Perioperative Care; Prednisone; Rabbits; Recombinant Fusion Proteins; Kidney Transplantation; Nephrology; Medicine (all)|
|Settore Scientifico Disciplinare:||Settore MED/14 - Nefrologia|
|Data di pubblicazione:||feb-2015|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1159/000371728|
|Appare nelle tipologie:||01 - Articolo su periodico|