T SALEHI1, P CLAYTON2
1Central Adelaide And Northern Renal And Transplantation Services, Adelaide, Australia, 2The University of Adelaide, Adelaide, Australia
Aim: To explore the impact of specific T cell suppressive agents on early outcomes post renal transplantation.
Background: The optimal T cell suppressive induction agent for low-moderate immunologic risk renal transplant recipients remains uncertain.
Methods: We conducted a retrospective analysis on early post-transplant outcomes in low-moderate immunologic risk renal transplant recipients from a single centre population, over a 36-month period. Patients received renal transplants before and after the centre’s induction protocol change to universal rATG. The cohorts encompassed the ‘pre-protocol’ cohort (receiving basiliximab or rATG [3mg/kg]) and the ‘post-protocol’ cohort incorporating patients receiving rATG (4.5mg/kg) on induction. The primary endpoints included biopsy proven acute rejection, major infection, leukopenia and all-cause mortality within 6 months post-transplant.
Results: A total of 169 patients were enrolled. 111 patients were transplanted pre-protocol: 84 received basiliximab and 27 received rATG (3mg/kg). 57 patients received rATG (4.5mg/kg) post-protocol. Acute rejection was significantly higher in the pre-protocol group (RR, 2.42; 95% confidence interval (CI), 1.14 to 5.13; P=0.01). Infection rates were overall similar (RR, 0.98; 95% CI, 0.72 to 1.33; P=0.88), with the exception of viral infections which was higher in the post-protocol group. Leukopenia rates were lower in the pre-protocol group (RR, 0.53; 95% CI, 0.38 to 0.73; P=0.0002). Secondary analyses of the three subgroups demonstrated that acute rejection was highest with basiliximab (34.5%) and lowest with rATG 3mg/kg (7.4%) (P = 0.005). CMV viraemia was highest with rATG 4.5mg/kg (17.5%) and lowest with rATG 3mg/kg (0%).
Conclusion: We identified significantly lower rates of acute rejection with rATG induction therapy compared to basiliximab, and overall similar complication rates. However, viral infections and leukopenia was observed most commonly with higher dose rATG.
Nephrology advanced trainee